Advanced Analyses of Coronary Computed Tomography Angiography to Predict Future Cardiac Events: A Meta-Analysis

Area of Science:

• Cardiovascular Imaging
• Radiology
• Preventive Cardiology

Background:

• Coronary computed tomographic angiography (CTA) is standard for anatomical assessment.
• Advanced CTA analyses like plaque characterization, CT-derived fractional flow reserve (CT-FFR), and radiomics show potential for predicting major adverse cardiovascular events (MACE).
• These advanced methods may enhance prognostic capabilities beyond conventional anatomical evaluation.

Purpose of the Study:

• To evaluate the additional prognostic value of advanced coronary CTA analyses in predicting MACE.
• To synthesize evidence on the association between various advanced CTA techniques and MACE risk.

Main Methods:

• A systematic meta-analysis was conducted using data from PubMed, Embase, and CENTRAL.
• Studies reporting advanced coronary CTA analyses for MACE prediction were included.
• Primary outcome was pooled hazard ratio (HR) for MACE; secondary outcome was change in C-index (ΔC index) compared to conventional models.

Main Results:

• 52 studies with 58,123 patients were included in the primary HR analysis.
• Most advanced CTA analyses, including CT-FFR, high-risk plaque features, and radiomics, were significantly associated with MACE.
• CT-FFR (HR: 6.14) and high-risk plaque (HR: 4.05) demonstrated the strongest associations with MACE.

Conclusions:

• Advanced coronary CTA analyses consistently associate with MACE occurrence.
• These techniques hold promise for refining cardiovascular risk stratification.
• Further comparative studies are needed to guide implementation due to heterogeneity in methods and targets.