Abstract 3263: Coronary Atherosclerotic Plaque Assessed by Multislice Computed Tomography Provides Incremental Prognostic Value over Framingham Risk Assessment
Framingham risk score (FRS) predicts 10-year coronary artery disease (CAD) mortality. Multislice computed tomography (MSCT) detects coronary atherosclerotic plaque (CAP) with high accuracy. Most major adverse cardiac events (MACE) occur in association with proximal CAP. We sought to assess if CAP assessed by MSCT provides incremental prognostic value over FRS. MSCT (64-slice) was performed on 227 individuals, (61% men, mean age 54 ± 12 years) without known CAD, referred for coronary evaluation. FRS was computed and subjects were stratified according to 10-year risk (73% low, 25% intermediate and 2% high). Presence of CAP was documented in 10 coronary segments and a CAP score was calculated (out of 10): left main (LM) and 3 segments (proximal, mid, distal) for 3 epicardial coronary arteries, respectively. Proximal CAP was defined as being present in LM or proximal left anterior descending (LAD). MACE [cardiac death, acute myocardial infarction (AMI) and revascularization] and length of follow-up were recorded. Over a follow-up of 2.3 ± 0.8 years, there were 18 patients with MACE (including 1 cardiac death and 3 AMI). CAP scores in low, intermediate and high FRS groups were 1.4 ± 1.9, 3.2 ± 2.4 and 4.6 ± 2.1, respectively (p < 0.001). Proximal CAP was a significant predictor of MACE (relative risk 7.41 [1.70 –32.2], p = 0.008). On receiver operating characteristic curve, CAP score was a better predictor of MACE than FRS [areas under the curve (AUC) 0.84 (p < 0.001) and 0.67 (p = 0.02), respectively, Figure⇓]. In individuals without known CAD, proximal CAP, assessed by MSCT, predicts MACE. CAP score provides incremental prognostic value over and above FRS.