Coronary computed tomography angiography derived risk score in predicting cardiac events.
J Cardiovasc Comput Tomogr. 2017 Jul - Aug;11(4):274-280. doi: 10.1016/j.jcct.2017.04.010. Epub 2017 Apr 27. Uusitalo V1, Kamperidis V2, de Graaf MA2, Maaniitty T3, Stenström I3, Broersen A4, Dijkstra J4, Scholte AJ2, Saraste A5, Bax JJ2, Knuuti J6.
BACKGROUND: We evaluated the prognostic value of an integrated atherosclerosis risk score combining the markers of coronary plaque burden, location and composition as assessed by computed tomography angiography (CTA).
METHODS: 922 consecutive patients underwent CTA for suspected coronary artery disease (CAD). Patients without atherosclerosis (n = 261) and in whom quantitative CTA analysis was not feasible due to image quality, step-artefacts or technical factors related to image acquisition or data storage (n = 153) were excluded. Thus, final study group consisted of 508 patients aged 63 ± 9 years. Coronary plaque location, severity and composition for each coronary segment were identified using automated CTA quantification software and integrated in a single CTA score (0-42). Adverse events (AE) including death, myocardial infarction (MI) and unstable angina (UA) were obtained from the national healthcare statistics.
RESULTS: There were a total of 20 (4%) AE during a median follow-up of 3.6 years (9 deaths, 5 MI and 6 UA). The CTA risk score was divided into tertiles: 0-6.7, 6.8-14.8 and > 14.8, respectively. All MI (n = 5) and most of the other AE occurred in the highest risk score tertile (3 vs. 3 vs. 14, p = 0.002). After correction for age and gender, the CTA risk score remained independently associated with AE.
CONCLUSIONS: Comprehensive CTA risk score integrating the location, burden and composition of coronary atherosclerosis predicts future cardiac events in patients with suspected CAD.