Journal of cardiovascular computed tomography · 2022
CT multivessel aggregate stenosis score: A novel point-of-care tool for predicting major adverse cardiac events.
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Maclean Edd, Mahon Ciara, Sehmi Joban, Kanaganayagam Gajen, Ngee Tan Thuan, Nicol Edward D
Аннотация
BACKGROUND: We evaluated the utility of a novel 15-point multivessel aggregate stenosis (MVAS) score for predicting major adverse cardiac events (MACE) in low-risk patients with suspected ischaemic symptoms undergoing CTCA. Prognostic performance was compared with the Coronary Artery Disease Reporting and Data System (CAD-RADS) classification and the 16-point Segment Involvement Score (SIS).
METHODS: 772 consecutive patients underwent CTCA and coronary artery calcification scoring (CACS) from 2010 to 2015. Coronary artery disease severity was calculated according to CAD-RADS class (0-5 ± vulnerability modifier), the SIS (0-16), and an MVAS score (0-15) based on the aggregate stenosis severity in all 4 coronary vessels (maximum 12 points) plus the presence of any high-risk plaque features (additional 3 points). 52 patients were referred directly for coronary angiography based on CTCA findings and were excluded; the remainder were followed-up for 64.6 ± 19.1 months.
RESULTS: 54 MACE were observed in 720 patients (7.5%); MACE patients had higher CAD-RADS class (3.92 ± 0.7 vs 0.91 ± 1.2, p < 0.0001), SIS (4.59 ± 2.7 vs 0.79 ± 1.2, p < 0.0001), and MVAS scores (10.1 ± 1.7 vs 1.7 ± 2.1, p < 0.0001). Adjusted Cox proportional hazards analysis identified CAD-RADS class (HR 2.96 (2.2-4), p < 0.0001), SIS (HR 1.29 (1.2-1.4, p < 0.0001), and MVAS score (HR 1.82 (1.6-2.1), p < 0.0001) as predictors of MACE. Adjusted receiver operating characteristic (ROC) analysis found MVAS a more powerful predictor of MACE than CAD-RADS and SIS (AUC: 0.92 vs 0.84 vs 0.83, p = 0.018).
CONCLUSIONS: CAD-RADS and SIS are reliable predictors of MACE, and the MVAS score provided incremental prognostic data. MVAS may potentiate risk stratification, particularly in institutions without advanced plaque analysis software.
METHODS: 772 consecutive patients underwent CTCA and coronary artery calcification scoring (CACS) from 2010 to 2015. Coronary artery disease severity was calculated according to CAD-RADS class (0-5 ± vulnerability modifier), the SIS (0-16), and an MVAS score (0-15) based on the aggregate stenosis severity in all 4 coronary vessels (maximum 12 points) plus the presence of any high-risk plaque features (additional 3 points). 52 patients were referred directly for coronary angiography based on CTCA findings and were excluded; the remainder were followed-up for 64.6 ± 19.1 months.
RESULTS: 54 MACE were observed in 720 patients (7.5%); MACE patients had higher CAD-RADS class (3.92 ± 0.7 vs 0.91 ± 1.2, p < 0.0001), SIS (4.59 ± 2.7 vs 0.79 ± 1.2, p < 0.0001), and MVAS scores (10.1 ± 1.7 vs 1.7 ± 2.1, p < 0.0001). Adjusted Cox proportional hazards analysis identified CAD-RADS class (HR 2.96 (2.2-4), p < 0.0001), SIS (HR 1.29 (1.2-1.4, p < 0.0001), and MVAS score (HR 1.82 (1.6-2.1), p < 0.0001) as predictors of MACE. Adjusted receiver operating characteristic (ROC) analysis found MVAS a more powerful predictor of MACE than CAD-RADS and SIS (AUC: 0.92 vs 0.84 vs 0.83, p = 0.018).
CONCLUSIONS: CAD-RADS and SIS are reliable predictors of MACE, and the MVAS score provided incremental prognostic data. MVAS may potentiate risk stratification, particularly in institutions without advanced plaque analysis software.