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Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential

Chadi Ayoub1,2,3, Leonard Kritharides3,4, Yeung Yam1

  • 1Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.

Heart and Vessels
|May 26, 2018
PubMed

Insights

Age-adjusted segment involvement score (aSIS) on coronary CT angiography improves prediction of death beyond traditional risk factors and obstructive coronary artery disease (CAD). This enhanced risk stratification may aid in managing patients with suspected or known CAD.

Area of Science:

  • Cardiology
  • Radiology
  • Preventive Medicine

Background:

  • Coronary atherosclerotic disease (CAD) burden assessed by segment involvement score (SIS) on coronary computed tomography angiography (CCTA) has prognostic implications.
  • Vascular age and premature atherosclerosis may be indicated by an 'age adjusted SIS' (aSIS).

Purpose of the Study:

  • To investigate the incremental prognostic value of aSIS in predicting all-cause death.
  • To determine if aSIS enhances risk stratification in patients undergoing CCTA.

Main Methods:

  • Prospective enrollment of 22,211 patients in the international CONFIRM study.
  • Calculation of aSIS from CCTA and follow-up for all-cause mortality.
  • Multivariable analysis adjusting for clinical factors and obstructive CAD, assessing hazard ratios, C-statistic, and reclassification improvements (NRI, IDI).

Main Results:

  • Higher aSIS was significantly associated with increased death risk (HR 2.40, p < 0.001) after multivariable adjustment.
  • aSIS demonstrated significant incremental prognostic value (NRI 0.36, p < 0.001; IDI 0.33, p = 0.009).
  • aSIS showed a higher mortality risk in patients without obstructive CAD (HR 3.48) compared to those with obstructive CAD (HR 1.79).

Conclusions:

  • aSIS provides incremental prognostic value beyond traditional risk factors and obstructive CAD.
  • aSIS may improve the risk stratification capabilities of CCTA.
  • aSIS may serve as a valuable marker for premature atherosclerosis and vascular age.

Keywords:
AtherosclerosisComputed tomographyCoronaryPrognosis

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