Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography

Christopher Naoum1, Daniel S Berman1, Amir Ahmadi1

  • 1From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.).

Insights

New nomograms for coronary artery disease (CAD) burden, using coronary computed tomography angiography, predict major adverse cardiovascular events (MACE). These age- and sex-specific tools improve risk assessment beyond traditional methods for better patient outcomes.

Area of Science:

  • Cardiology
  • Radiology
  • Preventive Medicine

Background:

  • Coronary artery disease (CAD) burden on coronary computed tomography angiography (CCTA) predicts major adverse cardiovascular event (MACE) risk.
  • Clinical decision-making is limited by a lack of nomographic data for CAD burden.
  • Development of age- and sex-specific nomograms for CAD burden using CCTA is needed.

Purpose of the Study:

  • To develop clinically pragmatic age- and sex-specific nomograms of CAD burden using CCTA.
  • To validate the prognostic utility of these nomograms in predicting MACE.
  • To assess the independence of SIS% in predicting cardiac events.

Main Methods:

  • Developed CAD nomograms using age-sex percentiles of segment involvement score (SIS) from 21,132 patients in the CONFIRM registry (Phase I).
  • Validated prognostic use in a separate cohort (Phase II, n=3030) by stratifying patients into SIS percentile groups (≤50th, 51-75th, >75th).
  • Compared annualized MACE rates and time to MACE using multivariable Cox models, adjusting for Framingham risk and chest pain typicality.

Main Results:

  • Age-sex percentiles of SIS showed good fit to polynomial curves (R²=0.86±0.12 for men, R²=0.86±0.14 for women).
  • Annualized MACE rates increased significantly with higher SIS% groups (2.1% in ≤50th, 3.9% in 51-75th, 7.2% in >75th; P<0.001).
  • Adjusted MACE risk was significantly higher in SIS% groups above the median (HR 1.9 for 51-75th, HR 3.4 for >75th; P<0.01).

Conclusions:

  • Clinically pragmatic age- and sex-specific nomograms for CAD prevalence using CCTA findings have been developed.
  • Global plaque burden measured by SIS% predicts cardiac events independently of traditional risk assessment.
  • These nomograms can enhance clinical decision-making for MACE risk stratification.
Abstract

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