{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:53:43Z","timestamp":1793296423855,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,1,20]]},"abstract":"\n Importance<\/jats:title>\n Risk stratification strategies in primary prevention of coronary events lack precision.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether prediction of first coronary events is improved by adding information on coronary atherosclerosis from coronary computed tomography angiography (CCTA) to a model using the pooled cohort equation (PCE) risk score tool and the coronary artery calcification score (CACS).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Observational cohort study including individuals aged 50 to 64 years randomly recruited from the general population and examined at 6 university hospitals in Sweden from 2013 to 2018, with a median follow-up of 7.8 years. A sample of 30\u202f154 individuals underwent cardiopulmonary imaging, physical examinations, routine laboratory tests, questionnaires, and\/or functional tests. This study included 24\u202f791 individuals without previous cardiovascular disease for whom high-quality CCTA images were available. Events were followed up via registers until September 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n The information used from the CCTA images was the extent of coronary atherosclerosis (segment involvement score), presence of noncalcified atherosclerosis, and presence of coronary obstructive disease (stenosis \u226550%).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The outcome was a composite of first occurrence of nonfatal myocardial infarction or death from coronary heart disease.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n During follow-up, 304 coronary events occurred. Segment involvement scores of 3 to 4 and greater than 4 and presence of noncalcified atherosclerosis were associated with hazard ratios of 2.71 (95% CI, 1.34-5.44), 5.27 (95% CI, 2.50-11.07), and 1.66 (95% CI, 1.23-2.22), respectively. In a model based on the PCE and CACS, CCTA-derived data improved risk discrimination (C statistic improved from 0.764 to 0.779;\n P<\/jats:italic>\n \u2009=\u2009.004) and risk reclassification (net reclassification improvement of 0.133 [95% CI, 0.031-0.165]), conferred a net correct upward reclassification of 14.2% in those with events and incorrectly classified 1.6% of participants not experiencing an event into a higher-risk category. Because of the low event rate in the cohort, reclassification mainly occurred in the group classified as at low risk (&amp;lt;5%) according to the PCE.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Information on coronary atherosclerosis from CCTA modestly improved risk prediction beyond traditional risk factors and CACS in identifying individuals at risk of coronary events and in need of primary prevention.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.21077","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T19:30:18Z","timestamp":1762716618000},"page":"245","source":"Crossref","is-referenced-by-count":44,"title":["Coronary Computed Tomography Angiography in Prediction of First Coronary Events"],"prefix":"10.1001","volume":"335","author":[{"given":"G\u00f6ran","family":"Bergstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Engstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences in Malm\u00f6, Lund University, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Bj\u00f6rnson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Adiels","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas S. 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