Increased coronary inflammation in all three coronary arteries, measured by FAI Score, was associated with a 29.8-fold higher risk of cardiac mortality compared to low inflammation.
Cohort (n=40,091)
Yes
Does coronary inflammation measured by FAI Score and AI-Risk algorithm from routine CCTA predict MACE and cardiac mortality in patients with or without obstructive CAD?
The FAI Score and AI-Risk algorithm derived from routine CCTA independently predict cardiac mortality and MACE, highlighting significant inflammatory risk in patients without obstructive CAD.
Hazard Ratio: 29.8 (95% CI 13.9–63.9)
p-value: p=<0.001
BACKGROUND: Coronary computed tomography angiography (CCTA) is the first line investigation for chest pain, and it is used to guide revascularisation. However, the widespread adoption of CCTA has revealed a large group of individuals without obstructive coronary artery disease (CAD), with unclear prognosis and management. Measurement of coronary inflammation from CCTA using the perivascular fat attenuation index (FAI) Score could enable cardiovascular risk prediction and guide the management of individuals without obstructive CAD. The Oxford Risk Factors And Non-invasive imaging (ORFAN) study aimed to evaluate the risk profile and event rates among patients undergoing CCTA as part of routine clinical care in the UK National Health Service (NHS); to test the hypothesis that coronary arterial inflammation drives cardiac mortality or major adverse cardiac events (MACE) in patients with or without CAD; and to externally validate the performance of the previously trained artificial intelligence (AI)-Risk prognostic algorithm and the related AI-Risk classification system in a UK population. METHODS: This multicentre, longitudinal cohort study included 40 091 consecutive patients undergoing clinically indicated CCTA in eight UK hospitals, who were followed up for MACE (ie, myocardial infarction, new onset heart failure, or cardiac death) for a median of 2·7 years (IQR 1·4-5·3). The prognostic value of FAI Score in the presence and absence of obstructive CAD was evaluated in 3393 consecutive patients from the two hospitals with the longest follow-up (7·7 years 6·4-9·1). An AI-enhanced cardiac risk prediction algorithm, which integrates FAI Score, coronary plaque metrics, and clinical risk factors, was then evaluated in this population. FINDINGS: In the 2·7 year median follow-up period, patients without obstructive CAD (32 533 81·1% of 40 091) accounted for 2857 (66·3%) of the 4307 total MACE and 1118 (63·7%) of the 1754 total cardiac deaths in the whole of Cohort A. Increased FAI Score in all the three coronary arteries had an additive impact on the risk for cardiac mortality (hazard ratio HR 29·8 95% CI 13·9-63·9, p<0·001) or MACE (12·6 8·5-18·6, p<0·001) comparing three vessels with an FAI Score in the top versus bottom quartile for each artery. FAI Score in any coronary artery predicted cardiac mortality and MACE independently from cardiovascular risk factors and the presence or extent of CAD. The AI-Risk classification was positively associated with cardiac mortality (6·75 5·17-8·82, p<0·001, for very high risk vs low or medium risk) and MACE (4·68 3·93-5·57, p<0·001 for very high risk vs low or medium risk). Finally, the AI-Risk model was well calibrated against true events. INTERPRETATION: The FAI Score captures inflammatory risk beyond the current clinical risk stratification and CCTA interpretation, particularly among patients without obstructive CAD. The AI-Risk integrates this information in a prognostic algorithm, which could be used as an alternative to traditional risk factor-based risk calculators. FUNDING: British Heart Foundation, NHS-AI award, Innovate UK, National Institute for Health and Care Research, and the Oxford Biomedical Research Centre.
Chan et al. (Wed,) conducted a cohort in Suspected coronary artery disease (n=40,091). High perivascular fat attenuation index (FAI) Score in three coronary arteries vs. Low FAI Score in three coronary arteries was evaluated on Cardiac mortality (HR 29.8, 95% CI 13.9-63.9, p=<0.001). Increased coronary inflammation in all three coronary arteries, measured by FAI Score, was associated with a 29.8-fold higher risk of cardiac mortality compared to low inflammation.
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