Coronary computed tomographic angiography and atherosclerosis: Prognostic validation of coronary scores in a Slovenian cohort

Abstract

Coronary computed tomographic angiography and atherosclerosis: Prognostic validation of coronary scores in a Slovenian cohort

Tadeja Poropat Flerin¹, Borut Jug², Daniel Košuta²

¹Institute of Radiology, University Medical Center Ljubljana, Zaloška 7, 1000Ljubljana, Slovenia

²Department of Vascular Diseases, University Medical Center Ljubljana, Zaloška 7, 1000Ljubljana, Slovenia

ABSTRACT

Background

Coronary computed tomographic angiography (CCTA) provides information on coronary atherosclerosis burden and extent. In the present analysis, we compared the prognostic impact of coronary scores (maximal coronary stenosis, segment involvement score [SIS] and segment stenosis  scores [SSS], and the CCTA-modified Duke score).

Methods

We retrospectively reviewed CCTA images of patients with suspected coronary obstruction and excluded patients who underwent planned revascularisation. Using Cox multivariate analysis, we estimated the hazard ratio (HR) with 95% confidence intervals (CI) for different coronary scores to predict death, myocardial infarction, and late unplanned revascularisations (as individual and composite endpoints). Model performance was evaluated using area under time-dependent receiver operating characteristic curves (AUC).

Results

We included 750 patients (median age 61 years, 54% women) with a median followup 1,465 days. Unadjusted HR for major cardiovascular events ranged from 3.87 (95%CI 1.49-10.0, p=0.005) for obstructive disease (>50% stenosis in any vessel) to 1.17 (1.09-1.25, p<0.001) for SIS (each additional segment involved). Predictions remained significant for all endpoints and after adjusting for coronary artery calcium score and risk factors. Area under curve (AUC) for coronary stenosis was 0.77 (95%CI 0.71-0.82), for SIS was 0.77 (95%CI 0.72-0.83), for SSS was 0.77 (95%CI 0.71-0.82), and for Duke score was 0.67 (95%CI 0.61-0.74).

Conclusion

Our study has confirmed that coronary atherosclerosis burden and extent independently predict major cardiovascular events in patients who had undergone CCTA, but were not referred for invasive diagnostic procedures and revascularisation