Who should be referred for a CT coronary calcium score? Introducing a simple patient risk questionnaire combining...

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Diagnostics

Background:

• Atherosclerotic cardiovascular disease (ASCVD) is a primary cause of mortality worldwide.
• Coronary artery calcium (CAC) scanning is a valuable tool for predicting ASCVD risk.
• Identifying individuals who will most benefit from CAC scanning is crucial for optimizing resource allocation and patient care.

Purpose of the Study:

• To evaluate the utility of a novel, user-friendly patient risk questionnaire (PRQ).
• To determine if the PRQ, incorporating traditional and non-traditional risk factors, can identify patients likely to benefit from CAC scanning.
• To assess the incremental value of the PRQ over the Pooled Cohort Risk Score (PCRS) in predicting CAC.

Main Methods:

• Utilized data from the EISNER Study, including 1332 participants.
• Assessed the relationship between PRQ scores and the extent of CAC.
• Compared the predictive performance of the PRQ against the PCRS for identifying CAC.

Main Results:

• A mean PRQ score of 5.6 ± 1.7 was observed.
• CAC scan negativity was high (95.5%) for PRQ scores 0-1, decreasing to 32.5% for PRQ score 8.
• A PRQ score of 3 or higher was linked to a 54% prevalence of CAC, with a 36% frequency of CAC score ≥100 in patients with PRQ score 8.
• The PRQ demonstrated significant incremental predictive value over the PCRS (cNRI = 0.20, P = 0.0004), primarily through risk down-stratification.

Conclusions:

• The PRQ is a simple and effective tool for identifying individuals with a high likelihood of a positive CAC scan.
• The PRQ can aid in selecting the most appropriate patients for CAC scanning.
• This questionnaire facilitates targeted use of CAC scanning, enhancing its clinical utility in cardiovascular risk assessment.