Incremental Value of Non-Gated Chest CT Coronary Artery Calcium Score in Predicting Major Adverse Cardiovascular...

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Acute coronary syndrome (ACS) necessitates accurate risk stratification for optimal patient management post-percutaneous coronary intervention (PCI).
• The GRACE score is a widely used tool, but its predictive accuracy for major adverse cardiovascular events (MACE) may be enhanced by incorporating imaging data.

Purpose of the Study:

• To assess the added value of non-gated chest CT coronary artery calcium scoring (CACS) to the GRACE score in predicting MACE after PCI in ACS patients.
• To compare the predictive performance of the GRACE score alone, GRACE score with CACS, and a combined clinical composite model.

Main Methods:

• A retrospective cohort study included 324 ACS patients who underwent PCI and non-gated chest CT.
• Patients were categorized into MACE and non-MACE groups, with a median follow-up of 18.7 months.
• Predictive performance was evaluated using receiver operating characteristic (ROC) curves and survival analysis.

Main Results:

• The combined GRACE score and CACS model showed significantly higher AUC values (training: 0.798, testing: 0.827) compared to the GRACE score alone (training: 0.702, testing: 0.758).
• A model incorporating clinical features alongside GRACE and CACS achieved the highest predictive performance (training AUC: 0.806, testing AUC: 0.857).
• High-risk stratification was identified in patients with GRACE score ≥140 and Agatston score ≥400, exhibiting the highest MACE incidence (94.4%).

Conclusions:

• Non-gated chest CT CACS significantly improves the predictive capability of the GRACE score for MACE following coronary intervention.
• Integrating CACS with clinical indicators further refines the prediction of cardiovascular events.
• This approach offers a robust and reliable tool for clinical risk stratification in ACS patients post-PCI.