Recent advancements in cardiac imaging have paved the way for more accurate assessments of chronic coronary syndromes (CCS). One significant breakthrough is the development of a composite cardiac computed tomography angiography (CCTA) score, which integrates multiple non-invasive imaging parameters to significantly improve risk stratification for patients with CCS.
The research, undertaken by a team at the Medical Faculty of the University of Heidelberg, focused on four key components derived from CCTA: the Agatston score, CAD-RADS classification, the number of high-risk plaques identified, and pericoronary adipose tissue attenuation (PCAT). These components were combined to form the composite score, with the goal of enhancing predictive accuracy for all-cause mortality, myocardial infarction, and the need for coronary revascularization.
Data was collected from 759 patients who underwent clinical CCTA evaluations between September 2020 and August 2022. During the median follow-up period of almost 600 days, the primary endpoint—comprising death, heart attacks, and surgical revascularization—was reached by 39 patients, representing roughly 5.1% of the cohort.
By implementing Cox proportional regression analysis, researchers determined the individual contributions of the four factors to patient outcomes. Notably, it was found the number of high-risk plaques was the strongest predictor of adverse events, with hazard ratios (HR) indicating more than twofold increases for affected patients. The composite CCTA score emerged as the most reliable predictor, outperforming traditional cardiovascular risk factors and individual CCTA parameters.
"A composite CCTA score derived from the Agatston score, CAD-RADS, the presence of plaques with high-risk morphology, and PCATRCA provides the most accurate prediction of adverse events," said the authors of the article, emphasizing the clinical relevance of their findings.
This research not only indicates the promising potential of utilizing composite scoring systems but suggests it may offer superior risk assessment capabilities, aligning patient management strategies with their actual cardiovascular risk profiles. Consequently, the composite score could be particularly beneficial for identifying high-risk individuals who may require intensified treatment and closer clinical follow-ups.
The researchers also underscored the limitations of relying solely on traditional assessment strategies, like the Agatston score or CAD-RADS alone, stating previous studies did not adequately support these techniques for comprehensive risk stratification.
"Such a composite CCTA score may identify high-risk individuals who may benefit from more intensified treatment and clinical follow-up," the authors noted, reinforcing the necessity for enhanced stratification methods within CCS patient populations.
Future studies are encouraged to explore the clinical efficacy of the composite CCTA score across diverse patient demographics and settings. Additional multicenter investigations could help validate these findings and potentially reshape the strategic framework for managing chronic coronary syndromes.