Coronary computed tomographic angiography and atherosclerosis: prognostic validation of coronary scores in a Slovenian cohort

Flerin, Tadeja Poropat; Jug, Borut; Kosuta, Daniel

doi:10.2478/raon-2026-0004

Figures & Tables

Flowchart of patient enrollment process.
CABG = coronary artery bypass graft; CACS = calcium scoring; CCTA = computed tomographic angiography; CTA = computed tomographic angiography; GUCH = grown-up congenital heart disease; TAVI = transcatheter aortic-valve implantation — Flowchart of patient enrollment process. CABG = coronary artery bypass graft; CACS = calcium scoring; CCTA = computed tomographic angiography; CTA = computed tomographic angiography; GUCH = grown-up congenital heart disease; TAVI = transcatheter aortic-valve implantation

Five-year survival curves for no atherosclerosis, non-obstructive and obstructive atherosclerosis (Log-scale).

Predictive accuracy of coronary scores: area under curve (AUC) comparison for stenosis, segment involvement score (SIS), segment stenosis scores (SSS) and Duke score.

Cox models for different coronary computed tomographic angiography (CCTA)-derived scoring systems and their association with clinical endpoints

	CV Death				MACE			MACE plus unplanned revascularization
	Model	HR	CI	p	HR	CI	p	HR	CI	p
Segment involvement score (SIS)	Base model	1.75	1.33–2.29	< 0.001	1.80	1.39–2.34	< 0.001	1.84	1.47–2.31	< 0.001
	Plus calcium score (log)	1.72	1.13–2.61	0.011	1.72	1.15–2.59	0.008	1.56	1.09–2.24	0.015
	Full model	1.56	1.03–2.37	0.038	1.61	1.07–2.42	0.023	1.69	1.17–2.45	0.005
Segment stenosis score (SSS)	Base model	1.16	1.08–1.24	< 0.001	1.17	1.09–1.25	< 0.001	1.18	1.11–1.25	< 0.001
	Plus calcium score (log)	1.13	1.01–1.26	0.026	1.14	1.03–1.26	0.010	1.12	1.03–1.23	0.009
	Full model	1.11	1–1.24	0.057	1.13	1.02–1.25	0.024	1.13	1.03–1.24	0.009
Modified Duke CAD score	Base model	1.48	1.14–1.92	0.003	1.54	1.2–1.96	< 0.001	1.66	1.35–2.02	< 0.001
	Plus calcium score (log)	1.25	0.9–1.73	0.192	1.27	0.93–1.75	0.132	1.34	1.03–1.74	0.032
	Full model	1.18	0.85–1.64	0.324	1.21	0.88–1.67	0.237	1.35	1.01–1.81	0.041
Maximal coronary stenosis grade	Base model	1.58	1.28–1.95	< 0.001	1.63	1.33–2	< 0.001	1.70	1.42–2.04	< 0.001
	Plus calcium score (log)	1.64	1.22–2.19	< 0.001	1.68	1.26–2.23	< 0.001	1.66	1.28–2.15	< 0.001
	Full model	1.54	1.16–2.04	0.003	1.58	1.2–2.09	0.001	1.66	1.3–2.12	< 0.001
Presence of any non-obstructive plaque	Base model	3.86	1.49–10.03	0.006	3.87	1.49–10.06	0.005	2.78	1.15–6.73	0.023
	Plus calcium score (log)	4.44	1.51–13.05	0.007	4.23	1.44–12.48	0.009	2.43	0.87–6.82	0.092
	Full model	3.53	1.19–10.44	0.023	3.57	1.21–10.6	0.022	3.24	1.16–9.08	0.025

Coronary risk score overview

Scoring system	Definition	Scoring range	Used in model(s)
Maximal coronary stenosis	Maximum stenosis severity observed across LAD, LCX, RCA according to CAD-RADS definition	0 - No stenosis1- 1–24% stenosis2 - 25–49% stenosis3 - 50–69% stenosis4 - 70–99% stenosis (≥ 50% if LM involved)5 - Occlusion	e.g., 30–49% stenosis of LAD (score = 2) and 70–99% stenosis of proximal RCA (score = 4) yields a maximal coronary stenosis of 4
Obstruction category	Categorized as none, non-obstructive, or obstructive	None - No stenosisnon-obstructive - 1–69% stenosisObstructive - ≥ 70 stenosis (≥ 50% if LM involved)	e.g., 30–49% stenosis of LAD (score = 2) and 70–99% stenosis of proximal RCA (score = 4) yields a categorisation of obstructive CAD
Segment involvement score (SIS)	Number of coronary segments with any stenosis; a segment is counted if there is any measurable stenosis (typically corresponds to ≥1 on a 0–5 scale)	0–15	e.g., isolated involvement of mid LAD and proximal RCA yields a SIS score of 2
Segment stenosis score (SSS)	Sum of all stenosis severity scores across 15 coronary segments	0–75	e.g., 30–49% stenosis of the mid LAD (score = 2) and 70–99% stenosis of the proximal RCA (score = 4) yields a SIS of 6
Duke CAD Score	Number of major vessels with ≥ 70% stenosis (score ≥ 4), + 1 if LADp also ≥ 70%	0 - None or single < 5 0% stenosis1 - ≥ 2 stenoses 30% to 49% (one proximal)2 - 2 stenoses 50–69% or 1 stenosis ≥ 70%3 - 3 stenoses 50-69% or 2 vessel or proximal LAD stenosis ≥70%4 - 3 stenosis ≥ 70% or 2 vessels with proximal LAD stenosis ≥ 70%5 - ≥ 50% LM stenosis	e.g., 30–49% stenosis of LAD (score = 2) and 50–69% stenosis of proximal RCA (score = 4) yields a Duke CAD score of 2

Baseline characteristics

Characteristic		N = 750¹
Sex (male)		346 (46%)
Age (years)		61 (52, 69)
Arterial hypertension		70 (9.3%)
Diabetes mellitus		25 (3.3%)
Dyslipidemia		43 (5.7%)
Smoking		28 (3.7%)
CACS	Zero	531 (71%)
	1–99	123 (16%)
	100–299	51 (6.8%)
	≥ 300	45 (6.0%)
Stenosis	None	542 (72%)
	1–24% stenosis	35 (4.7%)
	25–49% stenosis	61 (8.1%)
	50–69% stenosis	40 (5.3%)
	70–99% stenosis	59 (7.9%)
	Occlusion	13 (1.7%)
Obstruction	None	542 (72%)
	Non-obstructive	136 (18%)
	Obstructive	72 (9.6%)
¹n (%); Median (IQR); Mean (SD)

Coronary computed tomographic angiography and atherosclerosis: prognostic validation of coronary scores in a Slovenian cohort

Figures & Tables

FIGURE 1.

FIGURE 2.

FIGURE 3.

Cox models for different coronary computed tomographic angiography (CCTA)-derived scoring systems and their association with clinical endpoints

Coronary risk score overview

Baseline characteristics

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