RESUMO
BACKGROUND: We 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). METHODS: 772 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 â± âvulnerability 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 â± â19.1 months. RESULTS: 54 âMACE were observed in 720 patients (7.5%); MACE patients had higher CAD-RADS class (3.92 â± â0.7 vs 0.91 â± â1.2, p â< â0.0001), SIS (4.59 â± â2.7 vs 0.79 â± â1.2, p â< â0.0001), and MVAS scores (10.1 â± â1.7 vs 1.7 â± â2.1, p â< â0.0001). Adjusted Cox proportional hazards analysis identified CAD-RADS class (HR 2.96 (2.2-4), p â< â0.0001), SIS (HR 1.29 (1.2-1.4, p â< â0.0001), and MVAS score (HR 1.82 (1.6-2.1), p â< â0.0001) 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 â= â0.018). CONCLUSIONS: CAD-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.
