Coronary artery calcium scoring can reclassify absolute cardiovascular risk for selected asymptomatic patients in Australia when used in conjunction with traditional absolute risk assessment.
Does coronary artery calcium (CAC) scoring improve cardiovascular risk reclassification in primary prevention for selected patients in Australia?
This position statement recommends CAC scoring for selected Australian patients with moderate or low absolute cardiovascular risk with risk-enhancing factors to reclassify risk and guide management.
INTRODUCTION: This position statement considers the evolving evidence on the use of coronary artery calcium scoring (CAC) for defining cardiovascular risk in the context of Australian practice and provides advice to health professionals regarding the use of CAC scoring in primary prevention of cardiovascular disease in Australia. Main recommendations: CAC scoring could be considered for selected people with moderate absolute cardiovascular risk, as assessed by the National Vascular Disease Prevention Alliance (NVDPA) absolute cardiovascular risk algorithm, and for whom the findings are likely to influence the intensity of risk management. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) CAC scoring could be considered for selected people with low absolute cardiovascular risk, as assessed by the NVDPA absolute cardiovascular risk algorithm, and who have additional risk-enhancing factors that may result in the underestimation of risk. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score of 0 AU could reclassify a person to a low absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for low absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score > 99 AU or ≥ 75th percentile for age and sex could reclassify a person to a high absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for high absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: CAC scoring can have a role in reclassification of absolute cardiovascular risk for selected patients in Australia, in conjunction with traditional absolute risk assessment and as part of a shared decision-making approach that considers the preferences and values of individual patients.
Jennings et al. (Sat,) conducted a review in Cardiovascular disease (primary prevention). Coronary artery calcium (CAC) scoring vs. NVDPA absolute cardiovascular risk algorithm alone was evaluated. Coronary artery calcium scoring can reclassify absolute cardiovascular risk for selected asymptomatic patients in Australia when used in conjunction with traditional absolute risk assessment.