Prognostic Impact of CCTA According to Standard Cardiovascular Modifiable Risk Factors.

BACKGROUND

The prognostic value of coronary computed tomographic angiography (CCTA) findings across standard modifiable risk factor (SMuRF) categories has not been explored.

OBJECTIVES

We evaluated whether SMuRF burden modifies the prognostic value of the different coronary artery disease (CAD) categories on CCTA.

METHODS

Patients without prior CAD who underwent clinically indicated CCTA were included. CCTA findings were categorized as absent CAD (0% stenosis), nonobstructive CAD (1% to 49%), or obstructive CAD (≥50%). SMuRF burden was defined by hypertension, dyslipidemia, diabetes, and smoking, and classified from 0 to 4. The primary endpoint was all-cause mortality or myocardial infarction (MI).

RESULTS

Among 29,840 patients (mean age 64 ± 14 years, 53% men), 33% had absent CAD, 43% nonobstructive CAD, and 23% obstructive CAD. Over a median follow-up of 2 years, 2,030 patients (7%) experienced death or MI. Across all CAD categories, higher SMuRF burden was associated with higher cumulative incidence of death or MI rates and higher incidence rates (P < 0.001). Incidence rates per 1,000 person-years across SMuRF categories 0 to 4 increased from 10 to 74 in absent CAD, and 35 to 75 in obstructive CAD (P < 0.001). In adjusted models, each 1-SMuRF increase was associated with a higher risk across all CAD groups (HR: 1.41; 95% CI: 1.27-1.56 for absent CAD; HR: 1.26; 95% CI: 1.17-1.35 for nonobstructive CAD; HR: 1.29; 95% CI: 1.19-1.40 for obstructive CAD). Adding SMuRF burden to age, sex, body mass index, and CAD severity significantly improved prognostic discrimination (C-index 0.653-0.673; P < 0.001).

CONCLUSIONS

Across CCTA-defined stenosis categories, SMuRF burden provides incremental prognostic information beyond anatomic disease severity, supporting its integration into CCTA-based risk stratification and personalized preventive management.