Guideline-directed application of coronary artery calcium scores improved ASCVD risk stratification, with estimated 10-year numbers needed to treat to prevent one event ranging from 11 to 26.
Cohort (n=1,903)
Does the application of CAC scores according to ACC/AHA versus ESC/EAS guidelines differ in risk stratification and eligibility for primary prevention of ASCVD?
Guideline-directed application of CAC scoring improves risk stratification for primary prevention of ASCVD, though the proportion of eligible individuals varies significantly between ACC/AHA and ESC/EAS guidelines.
The 2018 ACC (American College of Cardiology)/AHA (American Heart Association) and 2021 ESC (European Society of Cardiology)/EAS (European Atherosclerosis Society) guidelines recommend coronary artery calcium (CAC) score for risk refinement in primary prevention of atherosclerotic cardiovascular disease (ASCVD). The study sought to compare CAC utility as a risk-refining tool following the ACC/AHA guideline using pooled cohort equations (PCE) or PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations and ESC/EAS guideline using SCORE2 (Systematic COronary Risk Evaluation 2). A total of 1,903 statin-naive participants 55 to 75 years of age, free of ASCVD and diabetes, with low-density lipoprotein cholesterol <190 mg/dL from the prospective population-based Rotterdam Study were included. Per the guidelines, we determined proportions of CAC scan–eligible and reclassified men and women, ASCVD incidence rates, and numbers needed to treat for 10 years (NNT 10y ). By the ACC/AHA (PCE), 18.3% of men and 11.9% of women, and by ACC/AHA (PREVENT), 13.4% of men and 3.4% of women were eligible for a CAC scan. By the ESC/EAS, 46.6% of men and 44.9% of women were CAC eligible. Proportions of uprisked and derisked individuals varied per guideline. Among ACC/AHA and ESC/EAS CAC-eligible individuals, incidence rates ranged from 9.3 to 23.8 per 1,000 person-years, and the estimated NNT 10y to prevent 1 ASCVD event, based on high-intensity statin use, varied from 11 to 26. The ACC/AHA and ESC/EAS guidelines differ in the selection and application of the CAC score for primary prevention of ASCVD. Guideline-directed application of CAC score in a middle-aged apparently healthy population improved risk stratification at an acceptable NNT 10y for both guidelines.
Pavlović et al. (Wed,) conducted a cohort in Primary prevention of atherosclerotic cardiovascular disease (ASCVD) (n=1,903). Coronary artery calcium (CAC) score risk refinement (ACC/AHA vs ESC/EAS guidelines) was evaluated on Proportions of CAC scan-eligible individuals, ASCVD incidence rates, and 10-year numbers needed to treat (NNT). Guideline-directed application of coronary artery calcium scores improved ASCVD risk stratification, with estimated 10-year numbers needed to treat to prevent one event ranging from 11 to 26.