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Updated: Aug 9, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary computed tomography plaque-based scores predict long-term cardiovascular events
Thais Pinheiro Lima1, Antonildes N Assuncao1, Marcio Sommer Bittencourt2
1Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil.
Insights
Coronary CTA plaque scores offer long-term prognostic value for cardiovascular events. Extensive non-calcified plaque in coronary artery disease patients independently predicts future cardiac events.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Preventive Cardiology
Background:
- Coronary computed tomography angiography (coronary CTA) scores assess plaque burden and characteristics for coronary artery disease (CAD) prognostication.
- The long-term prognostic utility of these coronary CTA scores remains incompletely defined.
Purpose of the Study:
- To evaluate the long-term prognosis of coronary CTA scores for predicting major adverse cardiac events (MACE) in symptomatic patients with suspected CAD.
Main Methods:
- Two multicenter prospective studies evaluated CAD extent using coronary CTA and various scores.
- A total of 222 patients were followed for a median of 6.8 years, with 73 experiencing MACE.
Main Results:
- The segment involvement score for non-calcified plaque (SISNoncalc) independently predicted MACE, offering incremental value over clinical data and CAD severity.
- Patients with obstructive CAD and SISNoncalc > 3 had a significantly higher risk of events (HR 4.27).
Conclusions:
- Coronary CTA plaque-based scores provide significant long-term prognostic value for up to 7 years in stable CAD.
- Extensive non-calcified disease (SISNoncalc > 3) in obstructive CAD patients independently predicts late cardiovascular events.
Objectives:
Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD.
Methods:
The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3-9.1) years, and 73 patients met the composite endpoints of MACE.
Results:
Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001).
Conclusions:
Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD.
Key Points:
• Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
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