Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score
Issued Date
2023-01-01
Resource Type
eISSN
2297055X
Scopus ID
2-s2.0-85177047844
Journal Title
Frontiers in Cardiovascular Medicine
Volume
10
Rights Holder(s)
SCOPUS
Bibliographic Citation
Frontiers in Cardiovascular Medicine Vol.10 (2023)
Suggested Citation
Tiansuwan N., Sasiprapha T., Jongjirasiri S., Unwanatham N., Thakkinstian A., Laothamatas J., Limpijankit T. Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score. Frontiers in Cardiovascular Medicine Vol.10 (2023). doi:10.3389/fcvm.2023.1264640 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91196
Title
Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score
Author's Affiliation
Other Contributor(s)
Abstract
Background: Coronary artery calcium (CAC) scanning is a valuable additional tool for calculating the risk of cardiovascular (CV) events. We aimed to determine if a CAC score could improve performance of a Thai CV risk score in prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk for asymptomatic patients with CV risk factors. Methods: This was a retrospective cohort study that enrolled asymptomatic patients with CV risk factors who underwent CAC scans between 2005 and 2013. The patients were classified as low-, intermediate-, or high-risk (<10%, 10%–<20%, and ≥20%, respectively) of having ASCVD within 10-years based on a Thai CV risk score. In each patient, CAC score was considered as a categorical variable (0, 1–99, and ≥100) and natural-log variable to assess the risk of developing CV events (CV death, non-fatal MI, or non-fatal stroke). The C statistic and the net reclassification improvement (NRI) index were applied to assess whether CAC improved ASCVD risk prediction. Results: A total of 6,964 patients were analyzed (mean age: 59.0 ± 8.4 years; 63.3% women). The majority of patients were classified as low- or intermediate-risk (75.3% and 20.5%, respectively), whereas only 4.2% were classified as high-risk. Nearly half (49.7%) of patients had a CAC score of zero (no calcifications detected), while 32.0% had scores of 1–99, and 18.3% of ≥100. In the low- and intermediate-risk groups, patients with a CAC ≥100 experienced higher rates of CV events, with hazard ratios (95% CI) of 1.95 (1.35, 2.81) and 3.04 (2.26, 4.10), respectively. Incorporation of ln(CAC + 1) into their Thai CV risk scores improved the C statistic from 0.703 (0.68, 0.72) to 0.716 (0.69, 0.74), and resulted in an NRI index of 0.06 (0.02, 0.10). To enhance the performance of the Thai CV risk score, a revision of the CV risk model was performed, incorporating ln(CAC + 1), which further increased the C statistic to 0.771 (0.755, 0.788). Conclusion: The addition of CAC to traditional risk factors improved CV risk stratification and ASCVD prediction. Whether this adjustment leads to a reduction in CV events and is cost-effective will require further assessment.