Abstract PR396: The Values of Calcium Score And Computed Tomographic Coronary Angiography to Predict Hard Cardiovascular Outcomes Independently And Their Respective Extra Values in Addition to Multi-Variable Risk Score

Background & Objectives: Acute coronary heart disease is under diagnosed during the post-operative period as indicated by sub-clinical tropoinin rise1. Multivarible risk scores do not perfectly classify risk. Computed tomography coronary angiogram (CTCA) along with calcium score (CACS) may finesse risk prediction. Our aim is to conduct a systematic review to determine whether CTCA and CACS are worthy new predictors when used alone or together with Framingham Risk Score (FRS). Materials & Methods: Medline, EMBASE, Web of Science and Cochrane Library have been searched with no restrictions. Results: The 162333 patients among the 33 included studies had a mixture of symptoms and risk at enrollment. Most studies predicted 10-years risk of cardiovascular events. CACS had moderate additional value to FRS 2002 in predicting all-cause mortality (Δ AUC= 0.20, CI 0.12-0.28) but provided no extra value to FRS 1998 in predicting the same outcome (Δ AUC = 0.03, CI -0.04-0.10). CACS had modest additional value in predicting composite cardiac events in both asymptomatic and symptomatic patients. The extra value was relatively less in shorter term (5 years) and in predicting stroke events. CTCA offered modest extra value in addition to FRS (Δ AUC = 0.07, CI 0.04-0.09). CTCA still offered extra value when CACS and FRS were utilised. Roughly a third of the mean Δ AUCs were statistically significant and two thirds either did not provide p value estimation or were not statistically significant. Apart from Δ AUC, all the other mean estimates did not contain relevant CI for meta-analysis. The number of vessels with obstructive disease positively correlated with the hazard of all-cause mortality. Three-vessel disease independently was the most hazardous (HR 3.22, CI 1.44 to 5.11). The pooled hazard ratios across subgroups reduced after adjustment for FRS.Conclusion: The context here is long-term risk prediction. CTCA and CACS are potential new predictors in addition to traditional FRS parameters, as reflected by Δ AUC. The ‘amount’ of added value is more difficult to translate in clinical practise. These also independently predict cardiovascular events even after adjusted for FRS. As indicated by the VISION Study1, further research is essential to identify the value, role and cost in short-term risk prediction in the pre-operative setting. References: 1. VISION Study Investigators. Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA.2012;307(21):2295-2304. Disclosure of Interest: None declared