CT-based cardiovascular risk stratification benefits in asymptomatic patients

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research Background Cardiovascular risks (CVR) stratification and assessment of atherosclerotic plaques vulnerability in asymptomatic patients are serious challenges in outpatient practice. The use of modern CT techniques can help to personalize stratification. Methods The study included ambulatory patients with suspected coronary heart disease, who underwent computed tomography coronary angiography (CTA) in 2019-2020. CVR was estimated via Score, ACC/AHA, Framingham, MESA scales, CTA was performed on 640-slice computed tomography station. The patients were divided into two groups: patent arteries and atherosclerotic lesions (30-99%). We analyzed of the estimated CVR distribution, using coronary arteries visualization as the cut-off. Then ROC analysis of the scales, and Agatson Index was performed. Results The study included 60 patients, mean age is 61,5 years (65% female). 36,7% had no atherosclerosis; 56,7% had 30-99% coronary artery stenosis.  Our results showed risks overestimation using the SCORE and Framingham scales (+33.33% and +52.38%) and underestimation using ACC/AHA and MESA (-33.33% and -9.52%) in patients without coronary atherosclerosis. The ROC analysis showed that the "standard" scales have no diagnostic significance for zero atherosclerosis (p > 0.05) or for >30% plaques (p > 0.05). Conclusion Our data shows a significant predictive superiority of CTA. Asymptomatic patients with zero or low coronary calcium with low estimated CVR may have a REAL high risk based on morphological plaque criteria.