Key result
CTCA stenosis ≥70% is linked to ~274% higher MACE risk versus no stenosis.
Why the study?
CTCA is gaining attention for stratifying MACE risk beyond ruling out CAD in symptomatic intermediate-risk patients, but the predictive ability of stenosis reporting needed evaluation.
Does the maximum degree of stenosis on CTCA predict major adverse cardiac events in symptomatic intermediate risk patients?
Cohort (n=1,003)
No
Does the maximum degree of stenosis on CTCA predict major adverse cardiac events in symptomatic intermediate risk patients?
Effect estimate: HR 3.74 (95% CI 2.161-6.465)
Absolute Event Rate: 23.4% vs 7.7%
p-value: p=<0.001
Maximum degree of stenosis on CTCA is a significant predictor of major adverse cardiac events in symptomatic intermediate-risk patients.
Supports CTCA stenosis for MACE prognostication in intermediate-risk patients; leaves open prospective validation before guiding management.
INTRODUCTION: The strength of CT coronary angiography (CTCA) is ruling out significant coronary artery disease (CAD) in symptomatic intermediate risk patients. CTCA is gaining attention as a tool for stratifying patients' risk of major adverse cardiac events (MACE). This study evaluated the ability of stenosis reporting on CTCA to predict MACE in patients undergoing investigation at Townsville University Hospital. METHODS AND RESULTS: One-thousand and three patients (1003) who underwent a CTCA between January 2015 and November 2023 were followed up until February 2024. For each patient, maximum degree of stenosis on CTCA, coronary artery calcium score (CACS) and cardiac risk factors were collected. Four-hundred and seventy-one (471) patients had no stenosis on CTCA, 181 had 1-49% stenosis, 237 had 50-69% stenosis and 114 had [Formula: see text]70% stenosis. One hundred and sixteen (116) patients had invasive coronary angiography (ICA) performed of which 29 had a subsequent percutaneous coronary intervention (PCI) and 9 had a coronary artery bypass graft (CABG). In patients with 70% or more stenosis on CTCA, the hazard ratio for suffering a three-point definition of MACE (all-cause mortality, myocardial infarction and stroke or TIA) was 3.74 compared to the 0% stenosis group. ROC curve analysis revealed similar performance of CTCA between subsets of the population. There was no statistically significant difference in the ability of CTCA to predict MACE between women and men, and between Aboriginal and/or Torres Strait Islander patients and other Australians. CONCLUSIONS: Maximum degree of stenosis on CTCA can predict MACE. The apparent predictive value of CTCA for MACE largely depends on the features extracted from CTCA and the definition of MACE used.
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Faulder et al. (2025) conducted a cohort in Suspected coronary artery disease (n=1,003). Maximum degree of stenosis ≥70% on CTCA vs. 0% stenosis on CTCA was evaluated on Major adverse cardiac events (composite of myocardial infarction, all-cause mortality, and stroke or TIA) (HR 3.74, 95% CI 2.161-6.465, p=<0.001). Maximum degree of stenosis of 70% or more on computed tomography coronary angiography significantly increased the risk of major adverse cardiac events compared to 0% stenosis (HR 3.74).
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