Abstract
Background
Pretest probability (PTP) calculators utilize epidemiological-level findings to provide
patient-level risk assessment of obstructive coronary artery disease (CAD). However,
their limited accuracies question whether dissimilarities in risk factors necessarily
result in differences in CAD. Using patient similarity network (PSN) analyses, we
wished to assess the accuracy of risk factors and imaging markers to identify ≥50%
luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.
Methods
We created four PSNs representing: patient characteristics, risk factors, non-coronary
imaging markers and calcium score. We used spectral clustering to group individuals
with similar risk profiles. We compared PSNs to a contemporary PTP score incorporating
calcium score and risk factors to identify ≥50% luminal narrowing on CCTA in the CT-arm
of the PROMISE trial. We also conducted subanalyses in different age and sex groups.
Results
In 3556 individuals, the calcium score PSN significantly outperformed patient characteristic,
risk factor, and non-coronary imaging marker PSNs (AUC: 0.81 vs. 0.57, 0.55, 0.54;
respectively, p < 0.001 for all). The calcium score PSN significantly outperformed
the contemporary PTP score (AUC: 0.81 vs. 0.78, p < 0.001), and using 0, 1–100 and > 100
cut-offs provided comparable results (AUC: 0.81 vs. 0.81, p = 0.06). Similar results
were found in all subanalyses.
Conclusion
Calcium score on its own provides better individualized obstructive CAD prediction
than contemporary PTP scores incorporating calcium score and risk factors. Risk factors
may not be able to improve the diagnostic accuracy of calcium score to predict ≥50%
luminal narrowing on CCTA.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AUC (Area under the curve), CAD (Coronary artery disease), CTA (Coronary CT angiography), HR (Hazard ratios), HRP (High-risk plaque), HU (Hounsfield units), MACE (Major adverse cardiac events), PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), PSN (Patient similarity network), PTP (Pretest probability), ROC (Receiver operating characteristics)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 25, 2022
Accepted:
March 22,
2022
Received in revised form:
March 5,
2022
Received:
October 22,
2021
Identification
Copyright
© 2022 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
