Comparing predictive risk to actual presence of coronary atherosclerosis on coronary computed tomography angiography: a retrospective cohort analysis

Abstract Background There is limited data supporting the ability of cardiovascular risk scores (CVRS) to accurately predict asymptomatic coronary artery disease (CAD). Purpose To examine the predictive accuracy of CVRS in detecting presence and extent of atherosclerosis, determined by coronary computed tomography angiography (CCTA). Methods Asymptomatic individuals without known CAD, undergoing a screening CCTA with available CVRS data, were examined retrospectively. Natural language processing of the CCTA report data extracted the coronary artery calcium score (CACS) and the extent and severity of coronary plaque (low, moderate, or extensive, using a modified CAD-RADS 2.0 classification). Normal was defined as both zero plaque and zero CACS. CVRS was categorized as high (>15%), moderate (10-15%), low (1-9%) and "zero" (<1%) risk. Results 828 individuals (median age 58.6, IQR=52.0, 65.3 years, 57% male) met inclusion criteria, and a zero, low, moderate, and high CVRS was identified in 13, 483, 113 and 219 individuals, respectively. Any degree of atherosclerosis was found in 548 scans (67% male). However, of the 137 males and 68 females with extensive atherosclerosis, 47 (34%) and 38 (56%) respectively had a low CVRS classification. Overall, 23% of males and 31% of females had CAD predicted by CVRS, with little to no agreement between CVRS and atherosclerosis burden (Cohen’s kappa: males, κ=0.149; females, κ=0.096). Conclusions In asymptomatic individuals without known CAD, CVRS does not reliably predict the presence and extent of CAD, and severe disease may be present in apparently low CVRS.Graphical AbstractFigure