Prognostic value of the GRIm-Score and high-risk plaque features on coronary computed tomography angiography in patients with chronic coronary syndrome

Purpose: The aim of this study was to evaluate the association between the Gustave Roussy Immune Score (GRIm-score) and high-risk plaque (HRP) and examined their prognostic significance in patients with chronic coronary syndrome (CCS).Materials and Methods: We retrospectively analyzed 356 patients with suspected CCS who underwent coronary computed tomography angiography (CCTA) between May 2020 and March 2024 at our institution. HRP was defined as ≥1 established CCTA vulnerability feature. The primary endpoint was a composite of all-cause mortality and urgent coronary revascularization. Results: HRP was observed in 126 patients (35.4%). These patients were older, more often male, and had higher rates of hypertension, worse renal function, and higher coronary calcium scores. Age, female sex, and hypertension were independent predictors of HRP. Event-free survival was worse in HRP-positive patients and in those with higher GRIm-scores. HRP, GRIm-score, and age independently predicted the primary endpoint.Conclusion: HRP on CCTA was associated with worse long-term outcomes in patients with CCS. The GRIm-score, applied here in cardiovascular disease, independently predicted mortality and urgent revascularization, providing prognostic value beyond plaque morphology. The combined assessment of plaque vulnerability and systemic inflammatory–nutritional status may improve risk stratification in patients with CCS.