Coronary artery volume index: a novel CCTA-derived predictor for cardiovascular events

Coronary computed tomography angiography (CCTA) provides critical prognostic information on plaque burden and stenosis severity of coronary arteries. We aimed to investigate the long-term prognostic value of coronary artery volume per myocardial mass as a potential new imaging parameter. Consecutive patients with suspected coronary artery disease (CAD) were included. Coronary artery volume index (CAVi) was defined as volume over myocardial mass. Additionally, obstructive CAD (≥ 70% stenosis) and segment severity score (SSS: sum of all segments scored according to lesion severity with 0 = no lesion, 1 = narrowing < 50%, 2 = stenosis 50–69% and 3 = stenosis ≥ 70%) were evaluated. Major adverse cardiovascular events (MACE) were defined as cardiac death, non-fatal myocardial infarction or revascularization. The association of CAVi with MACE was evaluated using Cox regression hazards ratios (HR) and Kaplan Meier curves. In a total of 325 patients, 36 (11.1%) patients experienced MACE during the mean follow-up of 5.4 ± 1.7 years. Patients with low-CAVi (< 27.9 mm³/g) experienced more MACE than patients with high-CAVI (17.2% versus 4.5%, p < 0.001, Kaplan Meier curve p = 0.001). SSS, obstructive CAD and low-CAVi were all significant predictors of MACE in univariable analysis (HR 1.14, 95% CI 1.09–1.19, p < 0.001; HR 5.51, 95% CI 2.86–10.60, p < 0.001; and HR 3.79, 95% CI 1.66–8.65, p = 0.002, respectively). CAVi maintained significant association with MACE when adjusted to SSS (CAVi HR 2.43, 95% CI 1.02–5.75, p = 0.04) or obstructive CAD (CAVi HR 2.4, 95% CI 1.002–5.75, p = 0.049). CAVi could further risk stratify patients without obstructive CAD when stratifying patients according to obstructive CAD (Kaplan–Meier curve p = 0.049). CAVi is a novel CCTA-derived imaging parameter, yielding independent prognostic value over stenosis and plaque burden.