LAUSR

Starting the first evidences reporting the role of coronary computed tomography angiography (CCTA) in improving the prognostic stratification of patients with suspected coronary artery disease (CAD) [1], there is a growing interest in testing the correlation between the noninvasively assessed coronary plaque features and the occurrence of major adverse cardiac events (MACE). In keeping with this trend, Andreini et al. [2] evaluated the ability of CT-adapted Leaman score (CT-LeSc), built considering localization of the coronary plaques, type of plaque (calcified, non calcified, and mixed), and degree of stenosis, to assess long-term prognosis of patients with non-obstructive CAD. Although the study showed that CT-LeSc score was an independent predictor of MACE, the results seem to be not enough compelling. Namely, the independent predictors of myocardial infarction plus allcause death at multivariate analysis in models 1 and 3 were nonobstructive CAD with a CT-LeSc≤5 (HR 2.05 and 1.55, respectively) and non-obstructive CAD with a CT-LeScN5 (HR 2.48 and 1.94, respectively). In my personal view, the fact that the CT-LeSc does not take in consideration some of the more advanced plaque features, like positive remodeling, low attenuation plaque, and napkin-ring sign, justifies the dim robustness of this score. Indeed, numerous studies demonstrated a strong link of the abovementioned features to outcomes [3–5]. The