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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Published on: August 28, 2018

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Prognostic value of coronary CTA-based classifications for predicting major events without obstructive coronary

Zengfa Huang1, Beibei Cao2, Xinyu Du1,3

  • 1Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.

Scientific Reports
|June 30, 2023
PubMed

Insights

A new classification system using coronary computed tomography angiography (CTA) effectively predicts major adverse cardiovascular events (MACE) in non-obstructive coronary artery disease (CAD) patients. This stenosis proximal involvement (SPI) classification is comparable to existing methods for risk stratification.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Non-obstructive coronary artery disease (NOCAD) poses a significant risk for major adverse cardiovascular events (MACE).
  • Accurate risk stratification in NOCAD patients is crucial for guiding clinical management.
  • Current classification systems for NOCAD may have limitations in predicting MACE.

Purpose of the Study:

  • To evaluate a novel classification system, stenosis proximal involvement (SPI), based on coronary computed tomography angiography (CTA) for MACE prediction in NOCAD patients.
  • To compare the prognostic performance of SPI classification against traditional NOCAD classification, Duke prognostic NOCAD index, and NOCAD-RADS.
  • To determine if plaque location identified by CTA provides additional risk prediction in NOCAD.

Main Methods:

  • A retrospective analysis of 4378 patients with suspected non-obstructive coronary artery disease (CAD) who underwent coronary CTA.
  • Patients were assessed using traditional NOCAD classification, Duke prognostic NOCAD index, NOCAD-RADS, and the new SPI classification.
  • SPI was defined by the presence of plaque in proximal coronary segments. MACE was the primary outcome, with a median follow-up of 3.7 years.

Main Results:

  • Kaplan-Meier analysis revealed significant associations between traditional NOCAD, Duke NOCAD index, NOCAD-RADS, and SPI classifications with increased MACE (all P < 0.001).
  • Multivariate Cox regression showed increased MACE risk with higher SPI grades (SPI 1: HR 1.20; SPI 2: HR 1.35) compared to SPI 0.
  • The SPI classification demonstrated non-inferiority to existing methods in predicting MACE and all-cause mortality.

Conclusions:

  • Coronary CTA-based SPI classification offers valuable prognostic information for MACE prediction in patients with non-obstructive CAD.
  • The SPI classification is non-inferior to traditional NOCAD, Duke NOCAD Index, and NOCAD-RADS.
  • Plaque location identified via coronary CTA may enhance risk prediction in the NOCAD population.

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