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

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death. Coronary artery calcium (CAC) strongly predicts the risk of ASCVD. There is a need to know who would benefit most from CAC scanning. We examined the utility of a new, simple, easy-to-use, and interactive patient risk questionnaire (PRQ), incorporating both traditional and non-traditional risk factors to identify those most likely to benefit from CAC scanning. Data from the EISNER Study was used to study the PRQ in relation to the extent of CAC and whether it added incremental value over the Pooled Cohort Risk Score (PCRS) for identifying CAC. Among 1332 participants a mean PRQ score of 5.6 ± 1.7 was obtained. Negative scans ranged from 95.5% for PRQ scores of 0-1 to only 32.5% for those with a PRQ score of 8. A PRQ score of 3 or more was shown to be associated with a 54% prevalence of CAC. The frequency of a CAC score >=100 was 0 with PRQ = 0-1 and 36% in patients with PRQ = 8. The cNRI of the PRQ score over the PCRS in predicting the presence of CAC was 0.20 (95% CI, 0.09- 0.30; P = 0.0004), mainly due to down-stratifying risk. A unique and simple PRQ identifies those most likely to have a positive CAC scan and may be useful to predict who will benefit most from CAC scanning, allowing for its use in those patients who are most appropriate.