The New Total Calcium score demonstrated high prognostic accuracy for predicting MACE at 1, 2, and 3 years (AUC 0.91, 0.80, and 0.81) in patients with severe aortic stenosis undergoing AVR.
Cohort (n=313)
Does the New Total Calcium (NTC) score predict major adverse cardiovascular events and mortality in patients with severe aortic stenosis undergoing aortic valve replacement?
A comprehensive computed tomography-derived calcium score accurately predicts MACE and mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
Effect estimate: AUC 0.91 at 1 year
BACKGROUND AND AIMS The prognostic significance of global calcium burden-including coronary artery (CAC), mitral annular (MAC), aortic valve (AVC), and thoracic aortic calcification (TAC)-as assessed by cardiac computed tomography (CCT), remains incompletely understood in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR). This study aimed to evaluate the prognostic impact of overall calcification burden in patients with severe AS undergoing AVR. METHODS A retrospective analysis of 313 patients with severe AS undergoing CCT before AVR between 2016 and 2019 was conducted. MAC, CAC, AVC were quantified using established scoring methods. For TAC, a total thoracic aortic (TTA) score was developed by evaluating calcifications in the ascending, descending and aortic arch. MAC, CAC, AVC, and TTA were integrated into a comprehensive scoring system, the New Total Calcium (NTC) score, using Random Forest models. Outcomes considered included MACE, all-cause mortality, and non-cardiovascular mortality over a 60-month follow-up. RESULTS Among 313 patients (mean age 81 years), 93% underwent transcatheter AVR. Severe CAC and MAC were observed in 11% and 7.7% of patients, respectively. During follow-up, 48% of patients died, with non-cardiovascular deaths accounting for 34% and MACE occurring in 43%. In this predominantly TAVR population, the TTA score predicted MACE (p = 0.01), all-cause mortality (p = 0.01), and non-cardiovascular mortality (p = 0.005). The NTC score demonstrated high prognostic accuracy for MACE at 1-, 2-, and 3-years, with AUC values of 0.91, 0.80, and 0.81, respectively. Validation in an external cohort of 100 patients confirmed its robustness. CONCLUSIONS In this predominantly transcatheter AVR cohort, the NTC score is a promising tool for risk stratification in patients with severe AS. These findings are primarily applicable to transcatheter AVR patients, and further validation in SAVR populations is warranted.
Savo et al. (Thu,) conducted a cohort in severe aortic stenosis (n=313). New Total Calcium (NTC) score was evaluated on MACE (AUC 0.91 at 1 year). The New Total Calcium score demonstrated high prognostic accuracy for predicting MACE at 1, 2, and 3 years (AUC 0.91, 0.80, and 0.81) in patients with severe aortic stenosis undergoing AVR.
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