Comprehensive Risk Assessment of LAD Disease Progression in CCTA: The CLAP Score Study

severe proximal LAD stenosis was detected in 32% (160/499) of patients by CCTA. MACE occurred in 12.5% of patients at follow-up. Significant predictors of MACE were LMBA > 80° (HR: 4.47; 95% CI: 3.80-6.70; <i>p</i> < 0.001), diabetes (HR: 2.94; 95% CI: 1.54-4.63; <i>p</i> = 0.031), chronic kidney disease (HR: 1.71; 95% CI: 1.31-6.72; <i>p</i> = 0.041), high-risk plaques (HR: 2.30; 95% CI: 1.45-3.64; <i>p</i> < 0.01), obstructive CAD (HR: 2.50; 95% CI: 1.50 to 4.10, <i>p</i> = 0.01), and calcium score (CAC) (HR: 1.05; 95% CI: 1.02-1.08, <i>p</i> = 0.004). The CLAP score demonstrated good discriminatory power in both the development (AUC 0.91; 95% CI: 0.86-0.96) and validation cohorts (AUC 0.85; 95% CI: 0.79-0.91); Conclusions: LMBA > 80°, diabetes, chronic kidney disease, obstructive CAD, CAC score >180 and high-risk plaques were significant predictors of MACE in CCTA patients. The CLAP score effectively predicted LAD disease progression, aiding in risk stratification and optimization of intervention strategies for suspected coronary artery disease.