SPC365

“Prognostic change” of adding Coronary Calcium Score and Genetic Risk Score to European SCORE2 in a moderate risk region

Session: Comunicações Orais - Sessão 29 - Score cálcio coronário
Speaker: Margarida Temtem

Congress: CPC 2023
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.2 Computed Tomography
Session Type: Comunicações Orais
FP Number: ---
Authors: Margarida Temtem; Roberto Palma Reis; Marco Serrão; Marina Santos; Débora Sá; Francisco Sousa; Mariana Rodrigues; Sónia Freitas; Eva Henriques; Sofia Borges; Graça Guerra; Ilídio Ornelas; António Drumond; Ana Célia Sousa; Maria Isabel Mendonça

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Introduction: </span></strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Cardiovascular disease is a public health issue remaining the leading cause of death worldwide. One of its main contributors is coronary artery disease (CAD), <span style="background-color:white">a complex multifactorial disease with the influence of hereditary and environmental factors</span>.&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">It&rsquo;s crucial to</span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;"> improve cardiovascular risk assessment </span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">which is a real challenge in our daily clinical practice. SCORE 2 enhanced the identification of individuals at higher risk of developing CAD, but it remains scanty. </span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;"><span style="color:black">Coronary Artery Calcification (CAC) score and Genetic contributions could improve CV risk stratification in primary prevention.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Purpose: </span></strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Evaluate the impact of including CAC score and Genetic Risk Score (GRS) to the European SCORE2 in MACE prediction and cardiovascular risk stratification in our asymptomatic population.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Methods:</span></strong> <span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">945 asymptomatic subjects (mean age 52.9&plusmn;6.8 years, 74.0% male) selected from the prospective arm of the GENEMACOR study were followed up during 5.4&plusmn;4.1 years. The population was categorized according to SCORE2 into three risk groups (low-intermediate &lt;5%; high 5-10%; very high &gt;10%). CAC score was performed by </span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">cardiac computed tomography and </span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">reported as Agatston units according to the Hoff Nomogram in low, moderate and high-risk categories. </span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">The GRS was created from 33 genetic variants associated with CAD by GWAS, choosing those with a hazard ratio (HR) higher than 1. </span></span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Multivariable Cox proportional hazard ratios (HR) with 95% con</span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">?</span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">dence intervals (95% CI) assessed the variables independently associated with CV events occurrence. We evaluated the discriminative ability of the Score2, CAC score and GRS using the Harrel C statistics.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Results: </span></strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Cox regression analysis showed that the highest categories of SCORE2, CAC and GRS remained in the equation with an HR of 16.6 (p=0.008), HR of 3.6 (p=0.006) and HR of 3.2 (p=0.022), respectively, when compared with the lowest categories.&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">C-statistic demonstrated</span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;"><span style="color:#010205"> that the predictive value for MACE was 0.671 for SCORE2, increased to 0.799 (p=0.002) when adding CAC score and improved to 0.808 (p=0.012) when adding mGRS (Table 1), </span></span><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;"><span style="color:black">showing a better discrimination capacity for MACE</span></span></span><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Conclusions:</span></strong> <span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Our results highlight the importance of adding CAC score and mGRS to SCORE2 in primary prevention to improve cardiovascular risk stratification and MACE prediction.&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,&quot;sans-serif&quot;"><span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.</span></span></span></p>