Andrea Igoren Guaricci1, Gianluca Pontone2, Natale Daniele Brunetti3, Fiorella De Rosa3, Deodata Montrone3, Marco Guglielmo2, Saima Mushtaq2, Laura Fusini2, Erica Maffei4, Filippo Cademartiri5, Luca Macarini6, Daniele Andreini7, Matteo Di Biase3, Antonio L Bartorelli7, Mauro Pepi2. 1. Cardiology Unit, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. Electronic address: andrea.guaricci@gmail.com. 2. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 3. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 4. Centre de Recherche, Department of Radiology, Montreal Heart Institute, Universitè de Montreal, QC, Canada. 5. Centre de Recherche, Department of Radiology, Montreal Heart Institute, Universitè de Montreal, QC, Canada; Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands. 6. Department of Radiology, University of Foggia, Foggia, Italy. 7. Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
Abstract
BACKGROUND: It is still unclear how to exploit information made available by coronary computed tomography angiography (CCTA) on coronary artery disease (CAD) features in order to better predicting major adverse cardiac events (MACEs). Aim of this study was to validate the prognostic role of a comprehensive and simplified CT-derived score in patients evaluated for suspected CAD. METHODS: A prospective registry included 477 consecutive symptomatic patients without known CAD who underwent clinically-indicated CCTA. All patients were followed-up for MACE occurrence for a period of 49±15-month. RESULTS: The mean CT Score was 10.5±10.8, with a MACE rate of 11.3%. There was a stepwise relationship between MACE rate during follow-up and CT Score values. MACEs were 1.9% in patients with CT Score<10 (reference group), 16.6% in those with CT Score 10-20 (OR 9.9, 95% C.I. 3.5-27.8 vs. reference group, p<0.001), 24.5% in those with CT Score 21-30 (OR 16.6, 95% C.I. 6.1-45.0 vs. reference group, p<0.001), and 47.4% in those with CT Score>30 (OR 46.1, 95% C.I. 13.0-162.9 vs. reference group, p<0.001) (p for trend <0.001). At ROC curve analysis, CT Score was the best predictor of MACE (AUC: 0.81, CI 95%: 0.78-0.84) as compared to Diamond and Forrester score (p<0.001), segment stenosis score (p<0.05) and segment involved score (p<.0.01). CONCLUSIONS: The use of an integrated score obtained with CCTA and based on the presence of remodeled and mixed atherosclerotic coronary plaques may improve MACE prediction in symptomatic patients at intermediate risk outweighing that provided by standard clinical and CCTA scores.
BACKGROUND: It is still unclear how to exploit information made available by coronary computed tomography angiography (CCTA) on coronary artery disease (CAD) features in order to better predicting major adverse cardiac events (MACEs). Aim of this study was to validate the prognostic role of a comprehensive and simplified CT-derived score in patients evaluated for suspected CAD. METHODS: A prospective registry included 477 consecutive symptomatic patients without known CAD who underwent clinically-indicated CCTA. All patients were followed-up for MACE occurrence for a period of 49±15-month. RESULTS: The mean CT Score was 10.5±10.8, with a MACE rate of 11.3%. There was a stepwise relationship between MACE rate during follow-up and CT Score values. MACEs were 1.9% in patients with CT Score<10 (reference group), 16.6% in those with CT Score 10-20 (OR 9.9, 95% C.I. 3.5-27.8 vs. reference group, p<0.001), 24.5% in those with CT Score 21-30 (OR 16.6, 95% C.I. 6.1-45.0 vs. reference group, p<0.001), and 47.4% in those with CT Score>30 (OR 46.1, 95% C.I. 13.0-162.9 vs. reference group, p<0.001) (p for trend <0.001). At ROC curve analysis, CT Score was the best predictor of MACE (AUC: 0.81, CI 95%: 0.78-0.84) as compared to Diamond and Forrester score (p<0.001), segment stenosis score (p<0.05) and segment involved score (p<.0.01). CONCLUSIONS: The use of an integrated score obtained with CCTA and based on the presence of remodeled and mixed atherosclerotic coronary plaques may improve MACE prediction in symptomatic patients at intermediate risk outweighing that provided by standard clinical and CCTA scores.
Authors: Andrea Igoren Guaricci; Delia De Santis; Mariangela Carbone; Giuseppe Muscogiuri; Marco Guglielmo; Andrea Baggiano; Gaetano Serviddio; Gianluca Pontone Journal: Biomed Res Int Date: 2018-01-15 Impact factor: 3.411