Medical Sciences
Prognostic Value of Plaque Burden Beyond Stenosis Severity in Patients with Stable Chest Pain Undergoing Coronary CT Angiography
By Ana Ezponda, José Marlon Rodríguez, Miguel Sogbe and 6 others.
Abstract
Introduction
Coronary computed tomography angiography (CCTA) is a noninvasive test for suspected coronary artery disease (CAD), but the prognostic value of integrating plaque burden into CAD-RADS 2.0 has not been fully evaluated. We aimed to assess whether the high-risk CAD-RADS 2.0 category, which combines stenosis severity and segment involvement score (SIS), provides prognostic information beyond stenosis severity in patients with stable chest pain.
Methods
We retrospectively included 563 consecutive patients with stable chest pain who underwent CCTA between 2017 and 2022. CAD-RADS 1.0 categories and CAD-RADS 2.0 plaque burden grades were assigned by experienced radiologists. High-risk CAD-RADS 2.0 was defined as CAD-RADS ≥ 3 or any CAD-RADS with P-SIS ≥ 3. The primary endpoint was major adverse cardiovascular events (MACEs). Given the limited number of events, multivariable analysis was restricted to clinically justified parsimonious Cox proportional hazards models. A model including age, sex, and significant stenosis was compared with a model including age, sex, and the high-risk CAD-RADS 2.0 category. A formally nested extended model additionally included severe-to-extensive plaque burden.