Advancements in coronary artery disease (CAD) treatment hinge on accurate risk prediction models, especially for patients with complex conditions.
A new study from the Guangzhou Red Cross Hospital has developed an innovative predictive model aimed at assessing the one-year risk of major adverse cardiovascular events (MACE) for patients with stable complex CAD. By integrating minimally invasive techniques with traditional scoring systems, researchers aim to refine patient management and improve clinical outcomes.
Coronary artery disease presents differently across patients, especially those with complex manifestations such as multivessel disease. Previously, assessing the severity of this condition relied heavily on invasive procedures, which pose significant risks. The study, published on March 1, 2025, highlights the potential of combining computed tomography-derived fractional flow reserve (CT-FFR) with the SYNTAX score—two tools meant to evaluate coronary health without the complications inherent to more invasive methods.
The research involved 369 patients collected retrospectively between January 2020 and September 2023. Participants underwent coronary computed tomography angiography (CCTA) and were divided randomly to create a training set (70%) for developing the predictive model and a validation set (30%) for evaluating its performance. The predictive factors were determined using least absolute shrinkage and selection operator (LASSO) regression followed by logistic regression to construct the final model and nomogram.
Among the seven independent predictors identified, the functional SYNTAX score was the strongest, indicating key insights from angiographic data. Other significant predictors included low-density lipoprotein cholesterol (LDL-C), left ventricular ejection fraction (LVEF), albumin levels, pulse pressure, angiotensin-converting enzyme 2 (ACE2) levels, and the presence of diabetes—each influencing MACE risk measurements with various odds ratios (OR).
The model produced compelling results, exhibiting good predictive accuracy with area under the curve (AUC) values of 0.843 for the training set and 0.844 for the validation set. Youden indices, which measure the effectiveness of diagnostic tests, were also promising, demonstrating values of 0.561 and 0.601, respectively, showcasing the model's reliability.
Notably, the findings advocate for the functional SYNTAX score's role as superior to the traditional anatomical score, bolstering its position as a frontline risk assessment tool. This results from its higher concordance with patient outcomes, potentially steering treatment pathways more effectively for complex CAD patients.
"This study demonstrates the importance of combining noninvasive assessments with established risk factors, which can lead to improved clinical strategies and outcomes for patients suffering from complex coronary artery diseases," wrote the authors of the article.
Upon establishing the predictive model, researchers emphasized the importance of early intervention. Those identified as high risk based on the newly developed model were advised to pursue elective revascularization strategies, alongside intensive management regimens focused on reducing LDL-C levels, optimizing LVEF, and adjusting albumin levels during treatment.
The researchers are confident the developed model has substantial clinical utility, advocating for its incorporation within existing treatment protocols to optimize healthcare resource allocation and patient care strategies.
Despite the promising outcomes, limitations acknowledged include the study's single-center retrospective design, which could introduce bias, and the necessity of external validation. The applicability across different populations remains uncertain, making it imperative for future multicenter studies to validate the model.
This innovative approach to predicting major adverse cardiovascular events creates pathways for more individualized patient care, calling attention to the life-changing potential of precise cardiovascular risk stratification.
With heart disease continuing as the leading global health burden, such forward-thinking developments mark significant milestones on the road to patient recovery and longevity.