CAPIRE score predicts long-term major cardiac events.

Background Coronary computed tomography angiography (CCTA) is the gold standard for non-invasive coronary atherosclerosis evaluation. Purpose To evaluate the performance of advanced atherosclerosis analysis by CCTA in predicting long-term major cardiac events in subjects enrolled in the multicenter CAPIRE study. Materials and methods CAPIRE prospectively enrolled subjects with suspected coronary artery disease (CAD) who underwent advanced plaque assessment by CCTA. Outcome measures were two combined endpoints: acute coronary syndrome (ACS) and major adverse cardiac events MACE (ACS+cardiac death+late non-urgent revascularization). Results The final CAPIRE population comprised 528 subjects (age 60 ± 8 years, 308 men). CCTA showed no CAD in 348 (65.9%) and CAD in 180. Follow-up was obtained in 522 subjects (98.8%) over a median of 7 (4.5–7) years. In total, 72 events were recorded (13 ACS, 14 cardiac deaths and 45 late non-urgent revascularizations). The volume of non-calcific plaques showed the best predictive ability for ACS (AUC = 0.90; 95% CI: 0.84–0.96), whereas the Leaman score was the best discriminator for MACE (AUC = 0.85; 95% CI: 0.81–0.89). At multivariate Cox regression analysis using an epidemiological approach, age (HR 1.04, 95% CI 1.00–1.07; p = 0.04), male sex (HR 2.76, 95% CI 1.43–5.32; p = 0.0025), glycated hemoglobin (HR 1.40, 95% CI 1.13–1.72;p = 0.0021), and non-calcific plaque volume (HR 1.01, 95% CI 1.00–1.01; p < 0.0001) remained significant independent predictors of MACE. Weighted HRs for independent predictors of MACE were used to create the new CAPIRE SCORE that was cross-validated yielding an AUC of 0.85. Conclusions In subjects with suspected CAD, our findings support a robust prognostic value of CCTA-derived high-risk atherosclerotic features combined with clinical variables to predict major cardiac events at long-term follow-up.