Why the study?
To determine the relationship between the ACC/AHA risk score and coronary and carotid artery plaque phenotypes assessed directly by CT angiography and MRI.
Do coronary CT angiography and carotid MRI improve phenotyping of atherosclerotic disease extent compared with ACC/AHA risk score alone in asymptomatic subjects eligible for statin therapy?
Do coronary CT angiography and carotid MRI improve phenotyping of atherosclerotic disease extent compared with ACC/AHA risk score alone in asymptomatic subjects eligible for statin therapy?
Direct imaging with coronary CTA and carotid MRI reveals significant discrepancies in atherosclerotic plaque burden compared to ACC/AHA clinical risk scores alone, suggesting clinical scores may misclassify disease extent in approximately 25% of statin-eligible patients.
ACC/AHA risk scores show variable plaque phenotype links on CTA/MRI; hypothesis-generating for imaging in primary prevention.
PURPOSE: To determine the relationship between the American College of Cardiology/American Heart Association (ACC/AHA) risk score and plaque phenotype of the coronary and carotid arteries assessed directly using CT angiography and MRI. MATERIALS AND METHODS: Asymptomatic subjects eligible for statin therapy by risk score were enrolled in a prospective study of disease burden using coronary artery calcium (CAC) scoring, coronary CT angiography, and MRI of the carotid arteries. Quartiles were calculated for noncalcified plaque, CAC, and average carotid wall volume and were compared with ACC/AHA risk quartiles. RESULTS: Two hundred three subjects were studied (60% men; mean age, 65 years). There were weak correlations between risk and carotid wall volume (Kendall tau = 0.29), noncalcified plaque (tau = 0.16), and CAC (tau = 0.33). ACC/AHA risk alone misclassified plaque extent compared with measurement by carotid wall volume, CAC, and noncalcified plaque in 22.1%, 24.1%, and 29.6% of subjects, respectively. On average, 13% of the subjects were underclassified, and 12.5% were overclassified. CONCLUSION: Approximately 25% of subjects had large discrepancies between ACC/AHA risk and plaque burden at imaging. These results suggest that clinical risk score models alone do not fully reflect the amount of atherosclerotic disease present.
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Chorath et al. (2020) studied this question.
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