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The long-term prognostic value provided by Coronary CT angiography

Published:October 31, 2022DOI:https://doi.org/10.1016/j.ejim.2022.10.020

      Highlights

      • Based on CCTA data, two clusters could be identified in patients with CAD.
      • The clusters are significantly different in mortality, MI, and late revascularization risks.
      • The clusters are characterized by the severity of stenosis in coronary arteries.
      • The severity of stenosis in the LM coronary artery is the strongest risk factor.
      • Our CCTA classifier outperformed calcium, Framingham, and Duke scores in discerning the clusters.

      Abstract

      Background

      Risk-stratification of patients has a major role in the prevention and treatment of cardiovascular disease. The aim was to find the most informative predictors of cardiovascular events in patients undergoing Coronary CT Angiography.

      Methods

      We carried out a secondary analysis of a large registry dataset. The included population comprises adults aged 18 or older who underwent Coronary CT Angiography of 64-detector rows or greater. We clustered patients based on their characteristics and compared the risk for poor clinical outcomes between the two clusters.

      Results

      There were two clusters of patients having different risks for all-cause death, myocardial infarction, and late revascularization [hazard ratios (95%CI) = 2.28 (2.02, 2.57), 1.63 (1.40, 1.89), and 2.46 (2.1, 2.88), all P < 0.001]. The severity of stenosis in the left main coronary artery adjusted for age and sex was the most significant predictor of the high-risk cluster [adjusted odds ratio (95%CI) = 3.35 (2.98, 3.77), P < 0.001]. The severity of stenosis in the first obtuse marginal branch of the left circumflex, distal left circumflex, distal left anterior descending, posterior descending, the first diagonal branch of the left anterior descending, and proximal right coronary artery were important as well (all adjusted odds ratios ≥ 2.52). Cluster profiling showed a higher performance for CT Angiography features (sensitivity = 97.4%, specificity = 85.7%, C-statistic = 98.7%) than calcium, Framingham, and Duke scores in identifying high-risk patients (C-statistic = 82.1, 77.0, and 88.2%, respectively).

      Conclusion

      Coronary CT Angiography can accurately risk-stratify patients concerning poor clinical outcomes.

      Graphical abstract

      Keywords

      Abbreviations:

      CAD (Coronary Artery Disease), CAD-RADS (Coronary Artery Disease – Reporting and Data system), CCTA (Coronary Computed Tomographic Angiography), CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry), dLAD (distal Left Anterior Descending), dLCX (distal Left Circumflex), Diag1 (first Diagonal branch of the LAD coronary artery), Diag2 (second Diagonal branches of the LAD coronary artery), dRCA (distal Right Coronary Artery), FFR (Fractional Flow Reserve), LAD (Left Anterior Descending), LCX (Left Circumflex), LM (left Main), MI (Myocardial Infarction), mLAD (mid-Left Anterior Descending), mRCA (mid-Right Coronary Artery), OM1 (first Obtuse Marginal branch of the LCX), OM2 (second Obtuse Marginal branch of the LCX), PDA (Posterior Descending Artery), pLAD (proximal Left Anterior Descending), pLCX (proximal Left Circumflex), pRCA (proximal Right Coronary Artery), RCA (Right Coronary Artery)
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