# Coronary computed tomographic angiography and atherosclerosis: prognostic validation of coronary scores in a Slovenian cohort

## TL;DR

This study shows that coronary computed tomographic angiography scores can predict major cardiovascular events in patients not undergoing invasive procedures.

## Contribution

The novel contribution is validating the prognostic value of coronary scores in a cohort not referred for invasive procedures.

## Key findings

- Coronary scores independently predict major cardiovascular events in patients who did not undergo invasive procedures.
- The area under the curve for coronary stenosis and SIS was around 0.77, indicating moderate predictive accuracy.
- Adjusting for calcium scores and risk factors did not diminish the predictive significance of coronary scores.

## Abstract

Coronary computed tomographic angiography (CCTA) provides information on coronary atherosclerosis burden and extent. In the present analysis, we compared the prognostic impact of coronary scores (maximal coronary stenosis, segment involvement score [SIS] and segment stenosis scores [SSS], and the CCTA-modified Duke score).

We retrospectively reviewed CCTA images of patients with suspected coronary obstruction and excluded patients who underwent planned revascularization. Using Cox multivariate analysis, we estimated the hazard ratio (HR) with 95% confidence intervals (CI) for different coronary scores to predict death, myocardial infarction, and late unplanned revascularizations (as individual and composite endpoints). Model performance was evaluated using area under time-dependent receiver operating characteristic curves (AUC).

We included 750 patients (median age 61 years, 54% women) with a median follow up 1,465 days. Unadjusted HR for major cardiovascular events ranged from 3.87 (95% CI 1.49–10.0, p = 0.005) for obstructive disease (> 50% stenosis in any vessel) to 1.17 (1.09–1.25, p < 0.001) for SIS (each additional segment involved). Predictions remained significant for all endpoints and after adjusting for coronary artery calcium score and risk factors. Area under curve (AUC) for coronary stenosis was 0.77 (95% CI 0.71–0.82), for SIS was 0.77 (95% CI 0.72–0.83), for SSS was 0.77 (95% CI 0.71–0.82), and for Duke score was 0.67 (95% CI 0.61–0.74).

Our study has confirmed that coronary atherosclerosis burden and extent independently predict major cardiovascular events in patients who had undergone CCTA, but were not referred for invasive diagnostic procedures and revascularization.