Prognostic utility of semi-quantitative coronary computed tomography angiography scores in the SCOT-HEART trial

Edd Maclean, Robert Cronshaw, David e. Newby, Edward Nicol, Michelle c. Williams

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Information from cardiac computed tomography angiography can be summarized using visual semi-quantitative scores. However, the optimal method and their prognostic utility is unknown.
Methods
Five semi-quantitative scores were calculated in the SCOT-HEART trial, including segment involvement score (SIS), segment stenosis score (SSS), CT Leaman (CT-LeSc), multivessel aggregate stenosis score (MVAS), and CAD-RADS 2.0 including plaque modifier (P). Prediction of fatal or non-fatal myocardial infarction and major adverse cardiovascular events (MACE) was compared to the 10-year cardiovascular risk score.
Results
Imaging was performed in 1,769 individuals (age 58±10 years, 56% male) with 41 (2.3%) experiencing myocardial infarction and 74 (4%) MACE over 4.9±1.1 years. P based on calcium score and SIS had good agreement (weighted Cohen’s kappa 0.79, 95% confidence interval [CI] 0.79, 0.79). SIS, SSS, CT-LeSec, and MVAS performed similarly for the prediction of myocardial infarction (area under the curve [AUC] 0.74, 0.75, 0.75, 0.74, all p>0.1) and MACE (AUC 0.73, 0.74, 0.74, 0.73, all p>0.1), and were superior to the cardiovascular risk score (AUC 0.62 and 0.65, both p<0.001). High semi-quantitative scores were associated with increased risk of myocardial infarction and MACE, with the greatest adjusted risk associated with CT-LeSc≥8 (Hazard ratio [HR] 5.6, 95% confidence interval [CI] 2.7, 11.6, p<0.001 and HR 5.2, 95% CI 3.1, 8.7, p<0.001 ) and SSS≥10 (HR 4.7, 95% CI 2.4, 8.9, p<0.001 and HR 5.3, 95% CI 3.3, 8.5, p<0.001).
Conclusions
Semi-quantitative scores performed similarly for the prediction of myocardial infarction and MACE, with all superior to the cardiovascular risk score.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
Early online date4 Sept 2023
DOIs
Publication statusE-pub ahead of print - 4 Sept 2023

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