ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1628622
This article is part of the Research TopicCoronary Physiology in the Spotlight: Advancing Diagnosis and Treatment in CAD and Microvascular DiseaseView all 7 articles
A LASSO-based predictive nomogram for obstructive coronary artery disease in double zero score patients: validation and cardiovascular education strategies
Provisionally accepted
- 1National Yang Ming Chiao Tung University, Taipei, Taiwan
- 2Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- 3National Sun Yat-Sen University, Kaohsiung, Taiwan
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Background: This study aimed to create a nomogram to predict a double-zero score for obstructive coronary artery disease (CAD) in a hospital-based cohort initially scoring zero. We compared its diagnostic performance with the Framingham risk score (FRS) and models for atherosclerotic cardiovascular disease (ASCVD). Methods: We retrospectively reviewed the clinical features and laboratory profiles of 634 participants with baseline zero coronary artery calcium scores. The target population consisted of individuals with a double-zero score. The primary endpoint was the diagnosis of obstructive CAD, defined as CAD-RADS ≥3 or vulnerable plaque formation on the second cardiac CT. The control group had a double-zero score, with no or less than 50% coronary stenosis. We developed a nomogram using a least absolute shrinkage and selection operation-derived logistic model. We assessed the models' discrimination and calibration abilities using the Hosmer–Lemeshow test. Results: Participants were monitored for an average period of 4.26 ± 2.30 years and were randomly allocated to training and validation sets at a ratio of 2.8:1. The study results indicated that 5.13% (24 of 467) in the training cohort and 4.19% (7 of 167) in the validation cohort developed a double-zero score with obstructive CAD progression. This nomogram incorporated four predictors: "systolic blood pressure," "hypertension," "body fat percentage," and "HbA1c." The nomogram demonstrated superior diagnostic performance compared to the FRS and ASCVD models, with lower values of Akaike information criterion and Bayesian information criterion values. The nomogram's discriminative ability, measured by the area under the curve, was 0.792 in the training cohort and 0.824 in the validation cohort. Conclusions: The validated nomogram provides valuable predictive potential for identifying high-risk subclinical coronary atherosclerosis, thereby supporting personalized primary prevention and education strategies.
Keywords: zero score, LASSO, Coronary CTangiography, Obstructive CAD, Plaque
Received: 14 May 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Liang, Chen, Wu, Yang, Wang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fu-Zong Wu, cmvwu1029@gmail.com
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