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

BackgroundCoronary 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. MethodsThis 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, [&ge;]50% stenosis) across different ASCVD risk categories and its relationship with MACE. ResultsAmong 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 [&ge;] 7.5% with OCAD group (adjusted hazards ratio: 5.101; p<0.001). ConclusionsCCTA 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.