Coronary artery disease grading by cardiac CT for predicting outcome in patients with stable angina

Christian U Oeing; Matthew B Matheson; Mohammad R Ostovaneh; Carlos E Rochitte; Marcus Y Chen; Burkert Pieske; Klaus F Kofoed; Joanne D Schuijf; Hiroyuki Niinuma; Marc Dewey; Marcelo F di Carli; Christopher Cox; João A C Lima; Armin Arbab-Zadeh

doi:10.1016/j.jcct.2023.07.004

Coronary artery disease grading by cardiac CT for predicting outcome in patients with stable angina

J Cardiovasc Comput Tomogr. 2023 Sep-Oct;17(5):310-317. doi: 10.1016/j.jcct.2023.07.004. Epub 2023 Aug 3.

Authors

Affiliations

¹ Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, USA; Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow-Klinikum, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany. Electronic address: Christian.Oeing@dhzc-charite.de.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, USA.
⁴ InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
⁵ Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
⁶ Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow-Klinikum, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
⁷ Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
⁸ Global RDC, Canon Medical Systems Europe BV, Zoetermeer, the Netherlands.
⁹ Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
¹⁰ Charité - Universitätsmedizin Berlin, Department of Radiology, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
¹¹ Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 37541910
DOI: 10.1016/j.jcct.2023.07.004

Abstract

Background: The coronary atheroma burden drives major adverse cardiovascular events (MACE) in patients with suspected coronary heart disease (CHD). However, a consensus on how to grade disease burden for effective risk stratification is lacking. The purpose of this study was to compare the effectiveness of common CHD grading tools to risk stratify symptomatic patients.

Methods: We analyzed the 5-year outcome of 381 prospectively enrolled patients in the CORE320 international, multicenter study using baseline clinical and cardiac computer-tomography (CT) imaging characteristics, including coronary artery calcium score (CACS), percent atheroma volume, "high-risk" plaque, disease severity grading using the CAD-RADS, and two simplified CAD staging systems. We applied Cox proportional hazard models and area under the curve (AUC) analysis to predict MACE or hard MACE, defined as death, myocardial infarction, or stroke. Analyses were stratified by a history of CHD. Additional forward selection analysis was performed to evaluate incremental value of metrics.

Results: Clinical characteristics were the strongest predictors of MACE in the overall cohort. In patients without history of CHD, CACS remained the only independent predictor of MACE yielding an AUC of 73 (CI 67-79) vs. 64 (CI 57-70) for clinical characteristics. Noncalcified plaque volume did not add prognostic value. Simple CHD grading schemes yielded similar risk stratification as the CAD-RADS classification. Forward selection analysis confirmed prominent role of CACS and revealed usefulness of functional testing in subgroup with known CHD.

Conclusion: In patients referred for invasive angiography, a history of CHD was the strongest predictor of MACE. In patients without history of CHD, a coronary calcium score yielded at least equal risk stratification vs. more complex CHD grading.

Keywords: Angina; CT; Coronary atherosclerosis; Coronary heart disease; Coronary imaging.

MeSH terms

Angina, Stable* / diagnostic imaging
Angina, Stable* / therapy
Calcium
Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / therapy
Humans
Multidetector Computed Tomography
Plaque, Atherosclerotic*
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors

Substances

Calcium