Background Various cardiovascular risk calculators predict future risk of incident events in the general population; an estimated risk>10% is considered an “actionable” threshold for lifestyle and/ or pharmacologic intervention in the United States. The presence of coronary artery calcium (CAC>0), high plaque burden (segment stenosis score- SSS>5), and vulnerable plaque characteristics (low attenuation plaque, positive remodeling, spotty calcifications)- VP by coronary computed tomography angiography (CTA) may further optimize such risk predictions.
Objectives To evaluate the performance of various risk calculators in predicting all 3 aforementioned surrogate coronary outcomes in patients with Rheumatoid Arthritis (RA).
Methods One hundred and fifty RA subjects without symptoms or diagnosis of coronary artery disease underwent CTA; Qualitative and quantitative plaque evaluation was carried out using a standard 15- coronary segment American Heart Association Model. Cardiac risk scores were calculated using different iterations of Framingham (classic, NCEP-ATPIII, D’ Agostino), Reynolds, and QRISK2 calculators. An estimated risk threshold >10% was used to predict CAC>0, SSS>5 and VP presence using Fisher’s exact tests.
Results QRISK2 had the highest sensitivity (40%) in identifying RA subjects with actionable threshold, followed by D’Agostino (29.3%), classic Framingham and NCEP-ATPIII (both with 11.3%), and Reynold’s (2.7%). Risk score adjustment based on EULAR recommendations did not significantly alter the numbers of patients identified as actionable risk. Importantly, QRISK2 score >10% performed superiorly to other calculators in predicting presence of coronary calcification, high plaque burden, and plaque with vulnerability characteristics (table).
Conclusions QRISK2 most sensitively identifies RA subjects with >10% risk for future cardiovascular event; at this cut-off, it has the highest performance of all calculators tested in identifying presence of coronary calcification, high plaque burden and vulnerable plaque features.
Disclosure of Interest None Declared