Incremental Prognostic Value of White Matter Hyperintensity Beyond Coronary Artery Disease Reporting and Data System...

This study aimed to assess the additional prognostic value of white matter hyperintensity (WMH) beyond Coronary Artery Disease Reporting and Data System (CAD-RADS) for major adverse cardiovascular events (MACE) in patients with suspected or known coronary artery disease (CAD).

This study included 1085 patients who underwent coronary computed tomography angiography and brain magnetic resonance imaging between November 2018 and December 2022. Time-dependent receiver operating characteristic curves were used to evaluate the predictive values, and the C-statistic was employed to determine their discriminatory power.

170 (15.7%) patients experienced MACE during a median follow-up of 63.1 months. WMH remained a significant and independent risk factor for predicting MACE after adjustments with clinical variables alone or with CAD-RADS. In the training set, the clinical-CAD-RADS-WMH model showed area under the curves (AUCs) of 0.719, 0.740, and 0.776 for predicting MACE at 1, 3, and 5 years, respectively. The model showed a consistent performance trend with AUCs of 0.819, 0.836, and 0.823 in the test set over 1, 3, and 5 years, respectively. Both the addition of WMH to the clinical model and to the clinical plus CAD-RADS model significantly increased the C-statistic index (p = 0.007, p = 0.038 in the training set and p = 0.002, p = 0.004 in the test set). These trends continued to be present when WMH was analyzed as a continuous variable.

An elevated WMH was related to a higher risk of MACE in patients with suspected or established CAD. Moreover, WMH demonstrated additional prognostic value for MACE beyond CAD-RADS.