Journal Article

Incremental Value of Non‐Gated Chest CT Coronary Artery Calcium Score in Predicting Major Adverse Cardiovascular Events by GRACE Score After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Zhao, Baoying, Dai, Xu, Huang, ZiGuang, Pan, Haoyan, Chen, Jianing, Zhang, Zhe, Xing, Zhaoyuan, Ding, Huan, Wen, Jing

2026

Overview

Objective To evaluate the incremental value of non‐gated chest CT coronary artery calcium score in enhancing GRACE score prediction of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods A retrospective cohort study was conducted on 324 ACS patients undergoing PCI and non‐gated chest CT. Patients were divided into MACE (n = 100) and non‐MACE (n = 224) groups with a median follow‐up of 18.7 months. The predictive performance of the GRACE score, Agatston score, and combined clinical composite model was evaluated using receiver operating characteristic (ROC) curves and survival analysis based on optimal cutoff values. Results Model 3 (GRACE + CACS) demonstrated AUC values of 0.798 and 0.827 in the training and testing cohorts, respectively, significantly outperforming Model 1 (GRACE) (training AUC = 0.702; testing AUC = 0.758). Model 4, incorporating clinical features, demonstrated optimal predictive performance (training set AUC = 0.806; testing set AUC = 0.857). The AUC differences were statistically significant (p < 0.05). Survival curves revealed the highest MACE incidence (94.4%, p < 0.01) in the high‐risk combined Ga1 group (GRACE ≥ 140 and Agatston ≥ 400). Conclusion The non‐gated chest CT coronary calcification score significantly enhances the predictive value of the GRACE score for major adverse coronary events (MACE) after coronary intervention. When combined with clinical indicators, the predictive power is further improved. Sensitivity analysis confirms the robustness of this finding, providing a reliable tool for clinical risk stratification. This study confirms that the combined GRACE score and coronary artery calcium score significantly improves the predictive efficacy of the risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and the predictive value is even better when combined with clinical characteristics.

• Publisher: John Wiley & Sons, Inc
• Subject: ACS / Acute Coronary Syndrome - diagnosis / Acute Coronary Syndrome - diagnostic imaging / Acute Coronary Syndrome - mortality / Acute Coronary Syndrome - surgery / Acute Coronary Syndrome - therapy / Acute coronary syndromes / Aged / Analysis / Angioplasty / Artificial intelligence / Atherosclerosis / Calcification / Cardiac arrhythmia / Cardiac patients / Computed Tomography Angiography - methods / Coronary Angiography - methods / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - mortality / Coronary heart disease / Coronary vessels / Coronary Vessels - diagnostic imaging / Correlation analysis / Female / Follow-Up Studies / GRACE risk score / Heart attacks / Heart failure / Hospitals / Humans / MACE / Male / Medical imaging / Medical research / Medicine, Experimental / Middle Aged / non‐gated chest CT coronary artery calcification score / Patients / PCI / Percutaneous Coronary Intervention - adverse effects / Predictive Value of Tests / Retrospective Studies / Risk Assessment - methods / Risk Factors / ROC Curve / Time Factors / Transluminal angioplasty / Treatment Outcome / Variables / Vascular Calcification - diagnostic imaging / Vascular Calcification - mortality / Veins & arteries