Progression Of Atherosclerotic Plaque Determined By Computed Tomography Angiography: A Practical CCTA-based SCORE

Abstract Funding Acknowledgements Type of funding sources: None. Background Currently, no recommendations are endorsed by the different scientific societies on the clinical use of repeated coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). Purpose The aim of this study was to develop and validate a practical and simple CCTA risk score to predict medium-term disease progression in symptomatic patients at low-to-intermediate probability of CAD. Methods Six hundred forty-six [430 (derivation cohort) and 216 (validation cohort)] symptomatic patients with two repeated, clinically indicated CCTA scans, non-obstructive stenosis, and absence of high-risk plaque at baseline CCTA were included. Disease progression was defined as the new occurrence of obstructive CAD (stenosis≥50%) and/or high-risk plaque features at follow-up CCTA. Results In the derivation cohort a total of 167 (27%) patients experienced disease progression. Hazard ratios for disease progression derived from multivariable Cox proportional hazard model were as follows: 1.8 (95% confidence interval: 1.1–2.8) for active smoking, 1.2 (1.1–1.3) for segment involvement score, 0.45 (0.29–0.69) for calcified plaque (vs. non-calcified plaque), 2.7 (1.8–4.0) for stenosis 25–49% (vs. stenosis <25%), and 1.6 (1.1–2.4) for left main or proximal left anterior descending coronary artery location. The C-statistic of the derived score was 0.69 (0.63–0.74) and 0.62 (0.54–0.71) in the derivation and validation cohorts, respectively. Figure shows 2 explicative cases. Conclusions The new CCTA-based risk score is a simple and practical tool which can predict mid-term CAD progression in symptomatic patients with non-obstructive CAD.