Guideline-Directed Application of Coronary Artery Calcium Scores for Primary Prevention of Atherosclerotic Cardiovascular Disease

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2025-04-01 DOI:10.1016/j.jcmg.2024.12.008

Jelena Pavlović MD, MSc , Daniel Bos MD, PhD , M. Kamran Ikram MD, PhD , M. Arfan Ikram MD, PhD , Maryam Kavousi MD, PhD , Maarten J.G. Leening MD, PhD

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引用次数: 0

Abstract

Background

The 2018 ACC (American College of Cardiology)/AHA (American Heart Association) and 2021 ESC (European Society of Cardiology)/EAS (European Atherosclerosis Society) guidelines recommend coronary artery calcium (CAC) score for risk refinement in primary prevention of atherosclerotic cardiovascular disease (ASCVD).

Objectives

This study sought to compare CAC utility as a risk-refining tool following the ACC/AHA guideline using pooled cohort equations (PCE) or PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations and ESC/EAS guideline using SCORE2 (Systematic COronary Risk Evaluation 2).

Methods

A total of 1,903 statin-naive participants 55 to 75 years of age, free of ASCVD and diabetes, with low-density lipoprotein cholesterol <190 mg/dL from the prospective population-based Rotterdam Study were included. Per the guidelines, we determined proportions of CAC scan–eligible and reclassified men and women, ASCVD incidence rates, and numbers needed to treat for 10 years (NNT_10y).

Results

By the ACC/AHA (PCE), 18.3% of men and 11.9% of women, and by ACC/AHA (PREVENT), 13.4% of men and 3.4% of women were eligible for a CAC scan. By the ESC/EAS, 46.6% of men and 44.9% of women were CAC eligible. Proportions of uprisked and derisked individuals varied per guideline. Among ACC/AHA and ESC/EAS CAC-eligible individuals, incidence rates ranged from 9.3 to 23.8 per 1,000 person-years, and the estimated NNT_10y to prevent 1 ASCVD event, based on high-intensity statin use, varied from 11 to 26.

Conclusions

The ACC/AHA and ESC/EAS guidelines differ in the selection and application of the CAC score for primary prevention of ASCVD. Guideline-directed application of CAC score in a middle-aged apparently healthy population improved risk stratification at an acceptable NNT_10y for both guidelines.

查看原文本刊更多论文

在指南指导下应用冠状动脉钙评分进行动脉粥样硬化性心血管疾病的一级预防。

背景：2018年ACC（美国心脏病学会）/AHA（美国心脏协会）和2021年ESC（欧洲心脏病学会）/EAS（欧洲动脉粥样硬化学会）指南推荐冠状动脉钙（CAC）评分用于动脉粥样硬化性心血管疾病（ASCVD）一级预防的风险细化。目的：本研究旨在比较CAC作为ACC/AHA指南（PCE）或prevention（预测心血管疾病事件风险）方程和ESC/EAS指南（SCORE2（系统冠状动脉风险评估2））下的风险优化工具的有效性。方法：共有1,903名年龄在55 - 75岁，无ASCVD和糖尿病，低密度脂蛋白胆固醇10y的他汀类药物初始受试者。结果：通过ACC/AHA (PCE)， 18.3%的男性和11.9%的女性符合CAC扫描条件；通过ACC/AHA (prevention)， 13.4%的男性和3.4%的女性符合CAC扫描条件。通过ESC/EAS， 46.6%的男性和44.9%的女性符合CAC条件。意外和危险个体的比例随指南而变化。在ACC/AHA和ESC/EAS符合cac条件的个体中，发病率为每1000人年9.3 - 23.8例，基于高强度他汀类药物的预防1例ASCVD事件的NNT10y估计为11 - 26例。结论：ACC/AHA和ESC/EAS指南在选择和应用CAC评分用于ASCVD一级预防方面存在差异。指南指导的CAC评分在中年明显健康人群中的应用，在两个指南可接受的NNT10y上改善了风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.