TY - JOUR
T1 - Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score
AU - van Rosendael, Alexander R.
AU - Shaw, Leslee J.
AU - Xie, Joe X.
AU - Dimitriu-Leen, Aukelien C.
AU - Smit, Jeff M.
AU - Scholte, Arthur J.
AU - van Werkhoven, Jacob M.
AU - Callister, Tracy Q.
AU - DeLago, Augustin
AU - Berman, Daniel S.
AU - Hadamitzky, Martin
AU - Hausleiter, Jeorg
AU - Al-Mallah, Mouaz H.
AU - Budoff, Matthew J.
AU - Kaufmann, Philipp A.
AU - Raff, Gilbert
AU - Chinnaiyan, Kavitha
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Villines, Todd C.
AU - Kim, Yong Jin
AU - Feuchtner, Gudrun
AU - Lin, Fay Y.
AU - Jones, Erica C.
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Marques, Hugo
AU - Rubinshtein, Ronen
AU - Achenbach, Stephan
AU - Dunning, Allison
AU - Gomez, Millie
AU - Hindoyan, Niree
AU - Gransar, Heidi
AU - Leipsic, Jonathon
AU - Narula, Jagat
AU - Min, James K.
AU - Bax, Jeroen J.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/10
Y1 - 2019/10
N2 - 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/)
AB - 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/)
KW - coronary computed tomography angiography
KW - risk stratification
KW - stable coronary artery disease
UR - http://www.scopus.com/inward/record.url?scp=85067210289&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2018.10.024
DO - 10.1016/j.jcmg.2018.10.024
M3 - Article
C2 - 30660516
AN - SCOPUS:85067210289
SN - 1936-878X
VL - 12
SP - 1987
EP - 1997
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 10
ER -