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Published on: August 28, 2018
The Prognostic Value of Coronary Arteries Calcium Scoring in a Primary Health Care Setting in Riyadh, Saudi Arabia: A
Nora Alalem1, Abdullah Alkhenizan2, Loay Basudan1
1Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU.
Insights
The QRISK2 score offers superior cardiovascular risk assessment compared to the ASCVD score, showing high concordance with Coronary Artery Calcium Scoring (CACS). Implementing QRISK2 first can improve cost-effectiveness and reduce radiation exposure.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Cardiovascular risk stratification is crucial for patient management.
- Coronary Artery Calcium Scoring (CACS), ASCVD Score, and QRISK2 score are common risk assessment tools.
- Evaluating these tools' predictive capacity in diverse patient populations is essential.
Purpose of the Study:
- To assess Coronary Artery Calcium Scoring (CACS), ASCVD score, and QRISK2 score.
- To evaluate their capacity to predict cardiovascular events in family medicine patients.
- To compare the concordance between these risk stratification methods.
Main Methods:
- Retrospective review of 218 patient records (18+ years) from January 2010 to March 2018.
- Inclusion of demographics, comorbidities, CACS, ASCVD score, QRISK2 score, and cardiovascular events.
- Analysis of associations and concordance between risk scores and outcomes.
Main Results:
- CACS was significantly associated with coronary events (p < .05).
- High CACS (>400) correlated with family history, prior events, and age.
- QRISK2 showed high concordance (90.6%) with CACS, ASCVD showed moderate (69.4%).
Conclusions:
- QRISK2 provides superior risk assessment and higher concordance with CACS.
- QRISK2 should precede CACS for initial cardiovascular risk stratification.
- This approach can enhance cost-effectiveness and minimize radiation exposure.
Background/Purpose:
Coronary Artery Calcium Scoring (CACS) by CT, the American Atherosclerotic Cardiovascular Disease (ASCVD) Score, and the British Cardiovascular Risk (QRISK2) score are the most frequently used cardiovascular risk stratification scores to predict cardiac outcomes and aid in the decision of implementing preventative and/or interventional measures. The aim of this study is to assess CACS, ASCVD score, QRISK2 score, and their capacity to predict cardiovascular events among family medicine patients in King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia.
Methodology:
All medical records of patients (18 years and above) who had a CACS done in Family Medicine Clinics at KFSH&RC from January 2010 to March 2018 were reviewed, retrospectively. The study variables included demographics, comorbidities, CACS, ASCVD Score, QRISK2 score, and cardiovascular events.
Results:
We included 218 patients. Our study population included: 77% men, a mean age of 51 years (SD±8), and a mean BMI of 29 kg/m2 (SD±5). CACS was significantly associated with coronary events (p-value < .05). There was significant association between high CACS (>400) and family history of cardiac disease (p-value = .006), prior cardiovascular events (p-value = .01) and advancing age (p-value < .001). High concordance was found between QRISK2 score and CACS (90.6%), and moderate concordance between ASCVD score and CACS (69.4%). Moderate concordance was found between ASCVD score and QRISK2 score (74.3%). The majority of the subjects (88%) fell into the low-risk group (CACS <100) with (63%) having a CACS of zero.
Conclusion:
QRISK2 cardiac assessment tool provides better risk assessment and higher concordance with CACS. To improve cost-effectiveness and minimize unnecessary radiation exposure, QRISK2 scoring should be implemented for initial cardiovascular risk stratification prior to ordering the CACS imaging modality.
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