Ayoub C, et al. - The incremental prognostic value of ‘age adjusted segment involvement score (SIS)’ [aSIS], which may be a marker of premature atherosclerosis and vascular age, was determined in the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study including prospectively enrolled consecutive patients. For each patient, aSIS was calculated on coronary computed tomography angiography (CCTA). Its incremental prognostic value was assessed. Higher aSIS was found to be related to increased death on multivariable analysis adjusted for clinical factors and presence of obstructive coronary atherosclerotic disease (CAD). Overall, an incremental prognostic value of aSIS was shown over and above that of traditional risk factors and obstructive CAD. Moreover, aSIS may enhance CCTA risk stratification.