Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events

ObjectiveTo evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE).Materials and methodsPooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed.ResultsPatients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3 vs. 76.3 mm3), NCPV (67.3 mm3 vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013).ConclusionCoronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power.