Alexander R van Rosendael1, Leslee J Shaw2, Joe X Xie2, Aukelien C Dimitriu-Leen3, Jeff M Smit3, Arthur J Scholte3, Jacob M van Werkhoven3, Tracy Q Callister4, Augustin DeLago5, Daniel S Berman6, Martin Hadamitzky7, Jeorg Hausleiter7, Mouaz H Al-Mallah8, Matthew J Budoff9, Philipp A Kaufmann10, Gilbert Raff11, Kavitha Chinnaiyan11, Filippo Cademartiri12, Erica Maffei13, Todd C Villines14, Yong-Jin Kim15, Gudrun Feuchtner16, Fay Y Lin17, Erica C Jones17, Gianluca Pontone18, Daniele Andreini18, Hugo Marques19, Ronen Rubinshtein20, Stephan Achenbach21, Allison Dunning22, Millie Gomez17, Niree Hindoyan17, Heidi Gransar6, Jonathon Leipsic23, Jagat Narula24, James K Min17, Jeroen J Bax25. 1. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. 2. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. 3. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 4. Tennessee Heart and Vascular Institute, Hendersonville, Tennessee. 5. Capitol Cardiology Associates, Albany, New York. 6. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California. 7. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. 8. King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia. 9. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California. 10. University Hospital, Zurich, Switzerland. 11. William Beaumont Hospital, Royal Oaks, Michigan. 12. Cardiovascular Imaging Center, IRCCS SDN, Naples, Italy. 13. Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. 14. Department of Medicine, Walter Reed National Military Medical Center, Bethesda. 15. Seoul National University Hospital, Seoul, South Korea. 16. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 17. Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. 18. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy. 19. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. 20. Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 21. Department of Medicine, University of Erlangen, Erlangen, Germany. 22. Duke Clinical Research Institute, Durham, North Carolina. 23. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. 24. Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 25. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl.
Abstract
OBJECTIVES: 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). 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/).
OBJECTIVES: 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). 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/).
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