CT multivessel aggregate stenosis score: A novel point-of-care tool for predicting major adverse cardiac events

BackgroundWe evaluated the utility of a novel 15-point multivessel aggregate stenosis (MVAS) score for predicting major adverse cardiac events (MACE) in low-risk patients with suspected ischaemic symptoms undergoing CTCA. Prognostic performance was compared with the Coronary Artery Disease Reporting and Data System (CAD-RADS) classification and the 16-point Segment Involvement Score (SIS).Methods772 consecutive patients underwent CTCA and coronary artery calcification scoring (CACS) from 2010 to 2015. Coronary artery disease severity was calculated according to CAD-RADS class (0–5 ?± ?vulnerability modifier), the SIS (0–16), and an MVAS score (0–15) based on the aggregate stenosis severity in all 4 coronary vessels (maximum 12 points) plus the presence of any high-risk plaque features (additional 3 points). 52 patients were referred directly for coronary angiography based on CTCA findings and were excluded; the remainder were followed-up for 64.6 ?± ?19.1 months.Results54 ?MACE were observed in 720 patients (7.5%); MACE patients had higher CAD-RADS class (3.92 ?± ?0.7 vs 0.91 ?± ?1.2, p ?< ?0.0001), SIS (4.59 ?± ?2.7 vs 0.79 ?± ?1.2, p ?< ?0.0001), and MVAS scores (10.1 ?± ?1.7 vs 1.7 ?± ?2.1, p ?< ?0.0001). Adjusted Cox proportional hazards analysis identified CAD-RADS class (HR 2.96 (2.2–4), p ?< ?0.0001), SIS (HR 1.29 (1.2–1.4, p ?< ?0.0001), and MVAS score (HR 1.82 (1.6–2.1), p ?< ?0.0001) as predictors of MACE. Adjusted receiver operating characteristic (ROC) analysis found MVAS a more powerful predictor of MACE than CAD-RADS and SIS (AUC: 0.92 vs 0.84 vs 0.83, p ?= ?0.018).ConclusionsCAD-RADS and SIS are reliable predictors of MACE, and the MVAS score provided incremental prognostic data. MVAS may potentiate risk stratification, particularly in institutions without advanced plaque analysis software.