Prognostic Value of Coronary CT in Outpatients with Chest Pain: A 5-Year MACE Analysis Stratified by ASCVD Risk

Background Coronary computed tomography angiography (CCTA) is recommended for the diagnosis of initial coronary artery disease (CAD) in patients with stable chest pain. We sought to understand the prevalence and severity of coronary stenosis observed via CCTA and to determine how integrating these anatomical findings with conventional 10-year atherosclerotic cardiovascular disease (ASCVD) scores could enhance risk stratification and guide clinical decisions.

This was an open-label, prospective, single-center observational study including 1,492 outpatients with stable chest pain who underwent CCTA. We collected data on ASCVD risk factors and followed up patients for 5 years to monitor for major adverse cardiovascular events (MACE). We analyzed the prevalence of obstructive CAD (OCAD, ≥50% stenosis) across different ASCVD risk categories and its relationship with MACE.

Among 1,492 patients, CCTA revealed OCAD in 16.0%. Over a 5-year follow-up, 7.2% of patients experienced MACE. The presence of OCAD significantly improved MACE prediction beyond ASCVD scores alone. Notably, patients with ASCVD < 7.5% and OCAD had a significantly higher MACE risk (adjusted hazards ratio: 3.634; p = 0.023) compared with those without OCAD. The highest risk was found in the ASCVD ≥ 7.5% with OCAD group (adjusted hazards ratio: 5.101; p<0.001).

CCTA provides significant incremental value for risk stratification in outpatients with stable chest pain. It helps uncover a high-risk group that might be underestimated by conventional ASCVD scores, supporting CCTA integration into clinical workups for earlier intervention and improved patient outcomes. Competing Interest Statement The authors have declared no competing interest. Clinical Trial This study is a retrospective observational analysis and therefore was not required to be registered as a clinical trial. Funding Statement The authors received no financial support for the research, authorship, and/or publication of this article. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was reviewed and approved by the relevant Institutional Review Board of Jecheon Myongji Hospital, Jecheon, Republic of Korea (IRB No. JCMJ 2020-01-001-001) and followed the principles of the latest version of the Declaration of Helsinki (2013). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data underlying this article will be available within the published article and from the corresponding author upon reasonable request.