Key result
CT-derived radiomics score yields ~5-point higher MACE discrimination over the PREVENT tool.
Why the study?
Cardiovascular disease prevention relies on accurate risk assessment, but existing scores are imprecise, and routine imaging could potentially be used opportunistically to predict risk.
Does a CT-derived structural cardiac and aortic radiomics score improve major adverse cardiovascular event prediction beyond PREVENT and CAC scores in adults undergoing routine chest CT?
Cohort (n=14,577)
Yes
Does a CT-derived structural cardiac and aortic radiomics score improve major adverse cardiovascular event prediction beyond PREVENT and CAC scores in adults undergoing routine chest CT?
A CT-derived radiomics score opportunistically generated from routine non-contrast chest CT improves cardiovascular risk stratification beyond current standard-of-care clinical scores.
May enhance MACE stratification on routine CT beyond PREVENT; leaves open clinical utility pending prospective validation.
BACKGROUND: Cardiovascular disease prevention relies on accurate risk assessment; however, existing scores are imprecise. Routine imaging may be opportunistically used to predict risk. OBJECTIVES: The authors tested whether computed tomography (CT)-derived cardiac and aortic structure predicts major adverse cardiac events (MACE) beyond standard-of-care scores. METHODS: The authors developed a least absolute shrinkage and selection operator model to predict cardiovascular mortality using "radiomics" features describing cardiac and aortic structure from 13,437 lung cancer screening CTs from the NLST (National Lung Screening Trial). They compared this score to the PREVENT (Predicting Risk of Cardiovascular Disease Events) tool and the coronary artery calcium (CAC) score in patients with routine chest CT and no prior MACE from Mass General Brigham. They calculated discrimination using Harrel's C-index and MACE rates in high-risk groups by the PREVENT score (≥7.5% risk) or the radiomics score (≥3.0% in men, ≥1.5% in women). RESULTS: In external testing (n = 14,577, mean age 61.1 ± 8.6 years, 47.5% male), 6.2% had incident MACE over a median of 5.7 years of follow-up. The radiomics score had higher discrimination for MACE than PREVENT (C-index 0.66 [95% CI: 0.64-0.68] vs 0.61 [95% CI: 0.59-0.63]) and was complementary to CAC (combined C-index 0.69 [95% CI: 0.67-0.71] vs CAC alone 0.66 [95% CI: 0.65-0.68]). High-risk patients by the radiomics score but not PREVENT had 3.6-fold higher MACE incidence than low-risk patients by both scores (23.1 [95% CI: 16.7-30.2] vs 6.5 [95% CI: 5.5-7.5] MACE per 1,000 person-years). Aortic surface-to-volume ratio, left ventricular volume, and left atrial short-axis length were among the most predictive features of MACE. CONCLUSIONS: CT-derived structural cardiac and aortic radiomics identified high-risk patients missed by clinical scores and further stratified risk among CAC risk groups. High-risk patients may benefit from intensified primary prevention.
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Oo et al. (2026) conducted a cohort in Cardiovascular risk (n=14,577). CT-derived cardiac and aortic radiomics score vs. PREVENT score and Coronary Artery Calcium (CAC) score was evaluated on Discrimination of major adverse cardiovascular events (C-index) (C-index 0.66, 95% CI 0.64-0.68). A CT-derived structural cardiac and aortic radiomics score demonstrated higher discrimination for major adverse cardiac events than the clinical PREVENT tool (C-index 0.66 vs 0.61).
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