![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk
Alexander R van Rosendael1, Leslee J Shaw2, Joe X Xie2
1Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
JACC. Cardiovascular Imaging
|January 21, 2019
Summary
A new comprehensive coronary computed tomography angiography (CTA) score improves risk prediction for cardiac events compared to the standard CAD-RADS assessment. This advanced CTA score better identifies patient risk by including plaque characteristics beyond just stenosis severity.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Current coronary computed tomography angiography (CTA) risk assessment primarily relies on maximal stenosis severity.
- Integrating plaque extent, location, and composition into a comprehensive model may enhance cardiovascular risk stratification.
Purpose of the Study:
- To evaluate the prognostic capability of a novel comprehensive coronary CTA score.
- To compare its performance against the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS).
Main Methods:
- A cohort of 2,134 patients with suspected coronary artery disease (CAD) was analyzed.
- The comprehensive CTA score (0-42) and CAD-RADS categories were compared for their predictive value.
- Internal and external validation using a 5-year follow-up dataset (n=1,971) was performed.
Main Results:
- The comprehensive CTA score demonstrated strong, independent predictive value for myocardial infarction or death.
- A model incorporating the comprehensive CTA score showed superior event discrimination (0.768) versus CAD-RADS (0.742).
- The comprehensive CTA score achieved significant net reclassification improvement (12.4%) and maintained accuracy in external validation.
Conclusions:
- The comprehensive CTA score offers improved risk discrimination and reclassification of cardiac events compared to stenosis-based CAD-RADS.
- Incorporating plaque characteristics enhances the prognostic accuracy of anatomic risk scores.
- The validated comprehensive CTA score provides a more robust tool for cardiovascular risk assessment.
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