https://doi.org/10.1007/s00392-024-02526-y
1GRN Klinik Weinheim Innere Medizin Weinheim, Deutschland; 2GRN Klinik Weinheim Kardiologie, Angiologie und Pneumologie Weinheim, Deutschland; 3UniversitätsSpital Zürich Klinik für Nuklearmedizin Zürich, Schweiz; 4GRN Klinik Weinheim Radiology Practice Weinheim, Deutschland; 5Kerckhoff Klinik GmbH Abteilung für Kardiologie Bad Nauheim, Deutschland; 6Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland
Background:
Agatston score, lumen narrowing categorized by CAD-RADS, atherosclerotic high-risk plaque features and pericoronary adipose tissue attenuation (PCAT), all of which can be assessed non-invasively by coronary computed tomography angiography (CCTA) aid risk stratification in patients with chronic coronary syndromes (CCS). However, few studies have so far investigated the combined prognostic value of these parameters.
Agatston score, lumen narrowing categorized by CAD-RADS, atherosclerotic high-risk plaque features and pericoronary adipose tissue attenuation (PCAT), all of which can be assessed non-invasively by coronary computed tomography angiography (CCTA) aid risk stratification in patients with chronic coronary syndromes (CCS). However, few studies have so far investigated the combined prognostic value of these parameters.
Aim:
To assess the combined prognostic value of Agatston score, CAD-RADS, high-risk plaques and PCAT in patients undergoing CCTA due to suspected or known CCS.
Methods:
Consecutive patients with clinical indication for CCTA and available clinical follow-up of ≥6 months after the CCTA examination were included. (i) Agatston score, (ii) CAD-RADS, (iii) the number of plaques with at least one high-risk feature and (iv) PCAT in the proximal 4 cm of the right coronary artery (PCATRCA) were measured, and a composite CCTA score was generated considering all four parameters. The primary endpoint encompassed all-cause mortality, myocardial infarction, and coronary revascularization during follow up.
Results:
In total, 759 patients (median age 68.0 (IQR 59.0-76.0) years, 352 (46.4%) female) were included. During a median follow-up of 591.5 (IQR 505.5-686.8) days, 79 (10.4%) reached the primary endpoint. Cox-proportional regression demonstrated that Agatston score, CAD-RADS, high-risk plaques per patient and PCATRCA all predicted the primary endpoint, independent of age and conventional cardiovascular risk factors. High-risk plaques provided the most robust prediction of the primary endpoint (HR=1.20, 95%CI=1.10-1.27, p<0.001), whereas the composite CCTA score outperformed all individual parameters (HR=1.45, 95%CI=1.26-1.68, p<0.001).
Conclusion:
Agatston score, CAD-RADS, high-risk plaque features and PCATRCA provide complementary prognostic information in patients with CCS. The combination of these imaging markers identifies high-risk individuals, who may benefit from more intensified treatment and clinical follow-up.