title: Feasibility of an automated quantitative computed tomography angiography-derived risk score for risk stratification of patients with suspected coronary artery disease.
abstract: Coronary computed tomography angiography (CTA) has important prognostic value. Additionally, quantitative CTA (QCT) provides a more detailed accurate assessment of coronary artery disease (CAD) on CTA. Potentially, a risk score incorporating all quantitative stenosis parameters allows accurate risk stratification. Therefore, the purpose of this study was to determine if an automatic quantitative assessment of CAD using QCT combined into a CTA risk score allows risk stratification of patients. In 300 patients, QCT was performed to automatically detect and quantify all lesions in the coronary tree. Using QCT, a novel CTA risk score was calculated based on plaque extent, severity, composition, and location on a segment basis. During follow-up, the composite end point of all-cause mortality, revascularization, and nonfatal infarction was recorded. In total, 10% of patients experienced an event during a median follow-up of 2.14 years. The CTA risk score was significantly higher in patients with an event (12.5 [interquartile range 8.6 to 16.4] vs 1.7 [interquartile range 0 to 8.4], p <0.001). In 127 patients with obstructive CAD (≥50% stenosis), 27 events were recorded, all in patients with a high CTA risk score. In conclusion, the present study demonstrated that a fully automatic QCT analysis of CAD is feasible and can be applied for risk stratification of patients with suspected CAD. Furthermore, a novel CTA risk score incorporating location, severity, and composition of coronary lesion was developed. This score may improve risk stratification but needs to be confirmed in larger studies.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Broersen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wehab
authors.initials: W
authors.lastname: Ahmed
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Medis Medical Imaging Systems B.V., Leiden, The Netherlands.
authors.forename: Pieter H
authors.initials: PH
authors.lastname: Kitslaar
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jouke
authors.initials: J
authors.lastname: Dijkstra
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Medis Medical Imaging Systems B.V., Leiden, The Netherlands.
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*