SPC365

Potential impact of replacing SCORE with SCORE-2 on risk classification and statin eligibility - a coronary calcium score correlation study

Session: Comunicações Orais (Sessão 5) - Risco CV, Prevenção e Reabilitação Cardíaca 1 - Foco nos Scores de Risco
Speaker: Mariana Sousa Paiva

Congress: CPC 2022
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Sousa Paiva; Daniel a. Gomes; Pedro Freitas; João Presume; Rita Reis Santos; Pedro Lopes; Daniel Matos; Sara Guerreiro; João Abecasis; Ana Coutinho Santos; Carla Saraiva; Miguel Mendes; António m. Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria,serif"><strong>Background: </strong>Recently, the European Society of Cardiology issued new algorithms to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), along with new age-specific thresholds to classify individuals as low-to-moderate, high, or very-high risk. &nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria,serif">The aim of this study was to compare the latest SCORE-2 model with the older SCORE (Systematic COronary Risk Evaluation) in their ability to identify individuals with high coronary artery calcium score (CACS), and assess the relationship between potential eligibility for statin therapy and CACS. </span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Cambria,serif"><strong>Methods: </strong>Individuals 40-69 years old without diabetes or known ASCVD were identified in a single center registry of patients undergoing CACS and coronary CT angiography for suspected coronary artery disease. SCORE and SCORE-2 were calculated and used with each patient&rsquo;s untreated LDL-C values to assess eligibility for statin therapy. High CACS was defined as an Agatston score &ge; 100. </span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Cambria,serif"><strong>Results: </strong>A total of 389 pts (46% men, mean age 58&plusmn;8 years) were included, of which 15% (n=60) were active smokers. The mean systolic blood pressure and untreated LDL-C values were 136&plusmn;17 mmHg and 155 &plusmn; 65 mg/dL, respectively. </span> </span></p>

<p><span style="font-size:12pt"><span style="font-family:Cambria,serif">The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 93%, 6% and 1% using the SCORE algorithm, and 42%, 44%, and 14% using SCORE-2, respectively. Overall, 218 patients (56%) would have their risk category revised upwards, while no patients would be downgraded.&nbsp; <strong>&nbsp;&nbsp;</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Cambria,serif">The median CACS was 5 (IQR 0-71 AU), with 166 patients (43%) having CACS = 0, and 81 (21%) presenting CACS values &ge; 100.<strong> </strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Cambria,serif">SCORE and SCORE-2 showed similar discriminative power to identify patients with CACS &ge; 100 (C-statistic 0.77, 95%CI 0.71-0.82, vs. 0.75, 95%CI 0.69-0.80, P=0.109 for comparison]. The up-reclassification of risk conveyed by SCORE-2 affected patients across all categories of CACS (Fig 1A). </span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Cambria,serif">The proportion of patients in whom statin therapy would generally be indicated was higher with the SCORE-2 criteria vs. the SCORE algorithm (61% vs. 29%, respectively, p&lt;0.001). The broadening of potential indication for statin therapy spanned all categories of CACS, including patients with CACS = 0 (Fig 1B).</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria,serif"><strong>Conclusion: </strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria,serif">Even though the discriminative power of SCORE-2 is similar to the older SCORE, the introduction of age-specific thresholds results in the up-reclassification of risk in roughly half of the patients. The application of SCORE-2 will broaden statin eligibility overall, not only in patients with high atherosclerotic burden, but also in those with CACS = 0. These findings support the use of risk modifiers in selected patients to improve the effectiveness of statin therapy.</span></span></p>