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Coronary computed tomography plaque-based scores predict long-term cardiovascular events

  • Cardiac
  • Published:
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Abstract

Objectives

Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD.

Methods

The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3–9.1) years, and 73 patients met the composite endpoints of MACE.

Results

Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17–4.40, p < 0.001).

Conclusions

Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD.

Key Points

• Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD.

• Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.

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Abbreviations

CAD:

Coronary artery disease

CTA:

Computed tomography angiography

ICA:

Invasive coronary angiography

LeSc:

Leaman score

MACE:

Major adverse cardiac events

SIS:

Segment involvement score

SSS:

Segment stenosis score

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Acknowledgements

We thank our stats team for their support in statistical analysis.

Funding

There was no funding for this research.

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Authors and Affiliations

  1. Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil

    Thais Pinheiro Lima, Antonildes N. Assuncao, Gabriela Liberato & Carlos Eduardo Rochitte

  2. Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil

    Marcio Sommer Bittencourt

  3. Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA

    Armin Arbab-Zadeh & Joao A. C. Lima

  4. Cardiovascular Magnetic Resonance and Computed Tomography Department, Heart Institute, InCor, University of Sao Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo, SP, 05403-000, Brazil

    Carlos Eduardo Rochitte

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  1. Thais Pinheiro Lima
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Correspondence to Carlos Eduardo Rochitte.

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Guarantor

The scientific guarantor of this publication is Carlos E. Rochitte.

Dr. Rochitte accepts official responsibility for the overall integrity of the manuscript (including ethics, data handling, reporting of results, and study conduct).

Conflict of interest

Thaís Pinheiro Lima receveid speaker fees of Pfizer. Marcio Sommer Bittencourt received a research grant from Sanofi; speaker fees of Novartis, Novo Nordisk, EMS, and GE Healthcare; and consulting fee from Bayer. Armin Arbab-Zadeh received grant support from Canon. Joao AC Lima received grant support from Canon. Carlos E. Rochitte receveid speaker fees from Pfizer. The others authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise and we thank our stats team for their support.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was not required in this study because this is a sub-study of two larger multicenter studies (CORE64 and CORE320) that received ethical approval.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in CORE64 and CORE320 studies.

Methodology

• retrospective.

• diagnostic or prognostic study.

• performed at one institution.

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Lima, T.P., Assuncao, A.N., Bittencourt, M.S. et al. Coronary computed tomography plaque-based scores predict long-term cardiovascular events. Eur Radiol 33, 5436–5445 (2023). https://doi.org/10.1007/s00330-023-09408-3

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