Simplified, non invasive CCTA based identification of high risk coronary artery disease - long term prognostic implications

Background/Introduction The CT-BCIS-Jeopardy score is a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant coronary artery disease (CAD), using coronary CT angiography (CCTA). Grading only lesions with ≥70% diameter stenosis and ranging from zero (non-significant CAD) to twelve (very extensive CAD), it allows accurate and fast identification of high-risk CAD. We aimed to assess the long-term prognostic value of the CT-BCIS-Jeopardy score. Methods Retrospectively, 337 patients with known or suspected CAD referred for CCTA between 2005 and December 2008 were included. The CT-BCIS-Jeopardy score was estimated for all patients using a purpose-developed online calculator, with a score of ≥6 indicating high-risk CAD. Endpoints were all-cause death or myocardial infarction ("hard events") and a composite of major adverse cardiovascular events (MACE). The Kaplan-Meier method was used to identify survival free of MACE, and Cox proportional hazard regression analysis was used to determine independent predictors for MACE. Results Mean patients’ age was 61.7±11 years and 216 (64%) were male. High-risk CAD was detected in 88 (26.1%) patients. During a median follow-up of 6.8 (IQR: 5.7-8.5) years, 47 (14%) patients had a hard event and 97 (29%) patients experienced any MACE. Compared to non-high-risk CAD, patients with high-risk CAD had 9.6-fold higher event rate for hard events [9 (19%) vs. 38 (81%); p<0.001] and 22-fold higher annual event rate for any MACE [19 (5.6%) vs. 78 (23%); p<0.001]. When adjusted for age, sex, BMI, and traditional CAD risk factors, a CT-BCIS-Jeopardy score of ≥6 was an independent strong predictor of both, all MACE and hard events. Conclusions The CT-BCIS-Jeopardy score is an excellent non-invasive long-term predictor of adverse cardiac events. High-risk CAD identified using the score is associated with significantly higher annual cardiac event rate.