Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score.

Adult Aged Computed Tomography Angiography Coronary Angiography / methods Coronary Artery Disease / complications Coronary Stenosis / complications Coronary Vessels / diagnostic imaging Female Humans Male Middle Aged Multidetector Computed Tomography Myocardial Infarction / etiology Plaque, Atherosclerotic Predictive Value of Tests Progression-Free Survival Reproducibility of Results Risk Assessment Risk Factors Severity of Illness Index

coronary computed tomography angiography risk stratification stable coronary artery disease

Journal

JACC. Cardiovascular imaging

ISSN: 1876-7591

Titre abrégé: JACC Cardiovasc Imaging

Pays: United States

ID NLM: 101467978

Informations de publication

Date de publication:
10 2019

Historique:

received: 21 06 2018

revised: 19 09 2018

accepted: 19 10 2018

pubmed: 21 1 2019

medline: 14 7 2020

entrez: 21 1 2019

Statut: ppublish

Résumé

This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS). Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971). The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort. The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).

Sections du résumé

OBJECTIVES

BACKGROUND

Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification.

METHODS

A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971).

RESULTS

The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort.

CONCLUSIONS

The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).

Identifiants

DOI: 10.1016/j.jcmg.2018.10.024 PMID: 30660516 PMC: PMC6635103

pubmed: 30660516

pii: S1936-878X(18)31036-2

doi: 10.1016/j.jcmg.2018.10.024

pmc: PMC6635103

mid: NIHMS1516479

pii:

doi:

Types de publication

Journal Article Multicenter Study Observational Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Validation Study

Langues

eng

Sous-ensembles de citation

Pagination

1987-1997

Subventions

Organisme : NHLBI NIH HHS

ID : R01 HL115150

Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

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