Author + information
- Received June 21, 2018
- Revision received September 19, 2018
- Accepted October 19, 2018
- Published online January 16, 2019.
- Alexander R. van Rosendael, MDa,b,
- Leslee J. Shaw, PhDc,
- Joe X. Xie, MDc,
- Aukelien C. Dimitriu-Leen, MDa,
- Jeff M. Smit, MDa,
- Arthur J. Scholte, MD, PhDa,
- Jacob M. van Werkhoven, MD, PhDa,
- Tracy Q. Callister, MDd,
- Augustin DeLago, MDe,
- Daniel S. Berman, MDf,
- Martin Hadamitzky, MDg,
- Jeorg Hausleiter, MDg,
- Mouaz H. Al-Mallah, MDh,
- Matthew J. Budoff, MDi,
- Philipp A. Kaufmann, MDj,
- Gilbert Raff, MDk,
- Kavitha Chinnaiyan, MDk,
- Filippo Cademartiri, MDl,
- Erica Maffei, MDl,
- Todd C. Villines, MDm,
- Yong-Jin Kim, MDn,
- Gudrun Feuchtner, MDo,
- Fay Y. Lin, MDb,
- Erica C. Jones, MDb,
- Gianluca Pontone, MD, PhDp,
- Daniele Andreini, MD, PhDp,
- Hugo Marques, MDq,
- Ronen Rubinshtein, MDr,
- Stephan Achenbach, MDs,
- Allison Dunning, MDt,
- Millie Gomez, MDb,
- Niree Hindoyan, BSb,
- Heidi Gransar, MDf,
- Jonathon Leipsic, MD, PhDu,
- Jagat Narula, MD, PhDv,
- James K. Min, MDb and
- Jeroen J. Bax, MD, PhDa,∗ ()
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
- cDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- dTennessee Heart and Vascular Institute, Hendersonville, Tennessee
- eCapitol Cardiology Associates, Albany, New York
- fDepartment of Imaging, Cedars Sinai Medical Center, Los Angeles, California
- gDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
- hKing Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- iDepartment of Medicine, Harbor UCLA Medical Center, Los Angeles, California
- jUniversity Hospital, Zurich, Switzerland
- kWilliam Beaumont Hospital, Royal Oaks, Michigan
- lDepartment of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- mDepartment of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- nSeoul National University Hospital, Seoul, South Korea
- oDepartment of Radiology, Medical University of Innsbruck, Innsbruck, Austria
- pDepartment of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
- qUNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
- rDepartment of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- sDepartment of Medicine, University of Erlangen, Erlangen, Germany
- tDuke Clinical Research Institute, Durham, North Carolina
- uDivision of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- vCardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Objectives This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS).
Background Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification.
Methods A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry] registry, n = 1,971).
Results Patients mean age was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort.
Conclusions The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. Comprehensive CTA risk score calculator is available at: http://126.96.36.199/calcApp/.
The research reported in this publication was funded, in part, by the National Institutes of Health (Bethesda, Maryland) under award number R01 HL115150, and also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). The Department of Cardiology of the Leiden University Medical Center, Leiden, the Netherlands, received research grants from Biotronik, Medtronic, Boston Scientific Corporation, and Edwards Lifesciences. Dr. van Rosendael has received grants from the Netherlands Heart Institute (Utrecht, the Netherlands). Dr. Scholte has received personal fees from Toshiba Medical Systems, Canon Medical Systems Europe, and GE Healthcare. Dr. Hausleiter has received personal fees from Abbott Vascular and Edwards LifeSciences. Dr. Budoff has received grants from GE and the National Institutes of Health. Dr. Raff has received grants from Heartflow. Dr. Jones has received personal fees from Cleerly, Inc. Dr. Leipsic has received personal fees from and has stock options from Circl CVI and Heartflow; and has received grants from GE Healthcare. Dr. Min has received personal fees from Arineta and GE Healthcare; and has received grants from the Dalio Foundation, the National Institutes of Health, GE Healthcare; and has equity interest in Cleerly, Inc. Dr. Bax has received grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards LifeSciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Wijns, MD, PhD, served as Guest Editor for this paper.
- Received June 21, 2018.
- Revision received September 19, 2018.
- Accepted October 19, 2018.
- 2018 American College of Cardiology Foundation
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