Clinical risk scores poorly correlate with baseline coronary plaque burden (Spearman's R ≤0.225) but are associated with plaque progression on serial CCTA imaging.
Do clinical ASCVD risk scores associate with coronary atherosclerotic plaque burden and progression in patients with suspected stable CAD?
Clinical ASCVD risk scores correlate poorly with baseline coronary plaque burden on CCTA but are significantly associated with plaque progression over time.
Absolute Event Rate: 0% vs 0%
Abstract Background Clinical atherosclerotic cardiovascular disease (ASCVD) risk scores are used in daily practice to guide treatment and referral for non-invasive imaging, yet lack diagnostic and prognostic precision when applied to individual patients. The association of these risk scores with coronary atherosclerotic plaque burden and progression remains unclear. Aims To evaluate the association of various global and regional ASCVD risk scores with coronary atherosclerotic plaque burden and composition assessed by coronary computed tomography coronary angiography (CCTA). Methods Retrospective, single-center study of 717 consecutive patients undergoing clinically indicated CCTA for suspected stable coronary artery disease (CAD) ≥2 years apart. At baseline, five widely used clinical risk scores for the estimation of 10-year ASCVD risk were calculated: Framingham Risk Score, Pooled Cohort Equation, Predicting Risk of Cardiovascular Events (PREVENT), Systematic Coronary Risk Evaluation (SCORE2), and Australian CVD risk. Coronary artery stenosis severity was determined according to the Coronary Artery Disease-Reporting and Data System (CAD-RADS). Qualitative plaque burden was measured using the modified Duke CAD Index which accounts for CAD extent, location, and stenosis severity. Results In the final study population of 717 patients (51% female, mean age 57±10 years; mean interscan interval 4.7±2.2 years), 486 (67.8%) had plaque present on baseline CCTA. Of these, 380 patients (78.2%) had evidence of calcified plaque and 106 patients (21.8%) had only non-calcified plaque, with 158 patients (22.0%) exhibiting obstructive stenosis (≥50%). The mean modified Duke CAD Index at baseline was 40.3±17.0. Correlation of the Framingham Risk Score (mean score 12.4±9.5), Pooled Cohort Equation (mean score 6.1±6.2), PREVENT (mean score 4.6±3.5), SCORE2 (mean score 4.8±3.5), and Australian CVD Risk score (mean score 4.0±3.4) with the baseline modified Duke CAD Index was weak (Spearman’s R = 0.225, 0.215, 0.170, 0.181, and 0.164, respectively). In multivariable linear regression analysis adjusted for baseline plaque burden, statin use, and interscan interval, all 5 clinical risk scores were associated with temporal change in modified Duke CAD Index (Figure 1). Conclusions In patients undergoing CCTA for suspected stable CAD, clinical risk scores correlate poorly with baseline coronary atherosclerotic plaque burden, however may associate with plaque progression on serial imaging. The utility of these clinical risk scores in guiding referral for CCTA requires further study.Figure 1. Figure 2.
Deres et al. (Sat,) reported a other. Clinical risk scores poorly correlate with baseline coronary plaque burden (Spearman's R ≤0.225) but are associated with plaque progression on serial CCTA imaging.