Related Experiment Video
Updated: Oct 4, 2025
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
CT multivessel aggregate stenosis score: A novel point-of-care tool for predicting major adverse cardiac events
Edd Maclean1, Ciara Mahon2, Joban Sehmi3
1William Harvey Research Institute, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, UK.
Insights
A new Multivessel Aggregate Stenosis (MVAS) score shows promise in predicting major adverse cardiac events (MACE) in patients with suspected ischemic symptoms. This novel score may enhance risk stratification, especially where advanced plaque analysis is unavailable.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) risk stratification is crucial for patients with suspected ischemic symptoms.
- Computed tomography coronary angiography (CTCA) is a key diagnostic tool.
- Existing scoring systems like Coronary Artery Disease Reporting and Data System (CAD-RADS) and Segment Involvement Score (SIS) have limitations.
Purpose of the Study:
- To evaluate the prognostic utility of a novel 15-point Multivessel Aggregate Stenosis (MVAS) score.
- To compare the predictive performance of MVAS against CAD-RADS and SIS for major adverse cardiac events (MACE).
- To assess MVAS's role in risk stratification for low-risk patients undergoing CTCA.
Main Methods:
- A cohort of 772 patients with suspected ischemic symptoms undergoing CTCA was analyzed.
- Coronary artery disease severity was assessed using CAD-RADS, SIS, and the novel MVAS score.
- Patients were followed for a median of 64.6 months to ascertain MACE.
- Statistical analyses included Cox proportional hazards and receiver operating characteristic (ROC) analyses.
Main Results:
- The MVAS score demonstrated a higher predictive accuracy for MACE compared to CAD-RADS and SIS (AUC 0.92 vs 0.84 vs 0.83, p=0.018).
- All three scores (CAD-RADS, SIS, and MVAS) were significant independent predictors of MACE.
- Patients experiencing MACE had significantly higher scores across all three assessment methods.
Conclusions:
- The novel MVAS score is a powerful predictor of MACE in patients with suspected ischemic symptoms undergoing CTCA.
- MVAS provides incremental prognostic information beyond CAD-RADS and SIS.
- The MVAS score may enhance risk stratification, particularly in centers lacking advanced plaque analysis capabilities.
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.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Mitral Stenosis IV: Nursing Management
01:28Imaging Studies for Cardiovascular System V: CT
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests