CorCalHot Line 11Prevention
Pooled Cohort Equations Versus Coronary Artery Calcium Score in Atherosclerotic Disease
Pooled cohort equations versus coronary artery calcium score in primary prevention of atherosclerotic cardiovascular disease
Presenting authorJoseph MuhlesteinInterventional / Structural Cardiology · Intermountain Medical Center, Utah, USAJ. Brent Muhlestein, MD, is Professor of Medicine in the Division of Cardiovascular Medicine at the University of Utah Spencer Fox Eccles School of Medicine and an interventional cardiologist at Intermountain Medical Center. He is Co-Director of Cardiology Research for Intermountain Healthcare and Director of the Interventional Cardiology Training Program at Intermountain Medical Center. He received his MD from the University of Utah in 1984 and completed internal medicine residency and cardiology fellowships at Duke University.
Overview
Pending PCE-CAC comparison leaves statin allocation in primary prevention unresolved; awaits definitive risk-discrimination results before practice change.
Key result
Pooled cohort equations compared to coronary artery calcium scoring for primary prevention of atherosclerotic cardiovascular disease currently have pending results.
Discussion
Expert reaction lands here the moment CorCal reports.
Expert takes
The CorCal trial is a large randomized clinical trial at Intermountain Health comparing coronary artery calcium (CAC) scoring versus pooled cohort equations (PCE) for guiding statin prescriptions in primary prevention. Key findings show CAC-guided recommendations result in significantly fewer statin prescriptions (22.3% vs 50.7% with PCE), largely because many older patients have zero or low CAC scores. A sub-study presented at AHA 2025 found incidental non-cardiac findings in 8.5% of CAC scans, including life-threatening conditions. Outcomes data comparing the two strategies are expected in early 2026, generating anticipation but no major controversy yet.
JL
Jeffrey L. Anderson
Cardiologist, Intermountain Health, Salt Lake City
“The question we want to answer is whether we can do a better job in selecting people who need a statin for primary coronary risk reduction by using the coronary artery calcium score, rather than just putting coronary risk factors into an equation. That is, is it more effective to use direct imaging to assess evidence of plaque burden or a risk probability equation? That's what we're aiming to find out.”
JB
Joseph B. Muhlestein
Co-director of cardiovascular research, Intermountain Healthcare
“We think that PCE gives statins to a lot of patients who don't really need them.”
Neil J. Stone
Bonow Professor of Medicine, Northwestern University
“The study confirms a large body of information that a deterministic approach, i.e., calcium score, outperforms a probabilistic approach on an individual patient level.”
Brent Muhlestein
Co-director of research, Intermountain Medical Center
“In nearly one in 10 of these kinds of heart scans, we're finding other possible medical issues. They could be nothing, as many abnormalities on these kinds of scans are. But they could be something more significant, as was the case for one study participant who had emergency surgery due to a finding on his CAC CT scan.”
Key Points
- The clinical evaluation compares pooled cohort equations with coronary artery calcium scoring for primary prevention of atherosclerotic cardiovascular disease.
- Primary assessment measures cardiovascular event risk discrimination, contrasting pooled cohort equations directly against coronary artery calcium scoring.
- Late-breaking trial presentation evaluates both risk-stratification modalities in primary prevention, with definitive comparative outcome data pending.
Main Result
Absolute Event Rate: 0% vs 0%