Acad Radiol. 2026 Oct 23:S1076-6332(26)00839-1. doi: 10.1016/j.acra.2026.10.004. Online ahead of print.
ABSTRACT
RATIONALE AND OBJECTIVES: This study aimed to assess the additional prognostic value of white matter hyperintensity (WMH) beyond Coronary Artery Disease Reporting and Data System (CAD-RADS) for major adverse cardiovascular events (MACE) in patients with suspected or known coronary artery disease (CAD).
MATERIALS AND METHODS: This study included 1085 patients who underwent coronary computed tomography angiography and brain magnetic resonance imaging between November 2018 and December 2022. Time-dependent receiver operating characteristic curves were used to evaluate the predictive values, and the C-statistic was employed to determine their discriminatory power.
RESULTS: 170 (15.7%) patients experienced MACE during a median follow-up of 63.1 months. WMH remained a significant and independent risk factor for predicting MACE after adjustments with clinical variables alone or with CAD-RADS. In the training set, the clinical-CAD-RADS-WMH model showed area under the curves (AUCs) of 0.719, 0.740, and 0.776 for predicting MACE at 1, 3, and 5 years, respectively. The model showed a consistent performance trend with AUCs of 0.819, 0.836, and 0.823 in the test set over 1, 3, and 5 years, respectively. Both the addition of WMH to the clinical model and to the clinical plus CAD-RADS model significantly increased the C-statistic index (p = 0.007, p = 0.038 in the training set and p = 0.002, p = 0.004 in the test set). These trends continued to be present when WMH was analyzed as a continuous variable.
CONCLUSION: An elevated WMH was related to a higher risk of MACE in patients with suspected or established CAD. Moreover, WMH demonstrated additional prognostic value for MACE beyond CAD-RADS.
PMID:42919703 | DOI:10.1016/j.acra.2026.10.004