Arteris Cardiovascular Outcome (ARCO) cohort study: carotid atherosclerotic burden significantly improves PROCAM and SCORE in middle aged subjects
There are few data about the predictive value of atherosclerosis imaging beyond traditional risk calculators.
We compared PROCAM and SCORE with carotid ultrasound (total plaque area, TPA) and arterial age (AA) was calculated in German and Swiss subjects without known cardiovascular diseases. Follow-up was obtained by phone or mail.
In 2842 subjects (age 50±8, 38% women) 137 (4.8%) cardiovascular events occurred (ASCVD: 41 myocardial infarctions, 16 strokes or TIA, 17 CABG, 28 PTCA, 35 coronary artery disease defined by invasive angiography) during a mean follow-up time of 5.4 (1-12) years. PROCAM risk was 5±6% (SCORE risk 1.3±1.6%). Area under the curve (AUC) were significantly (<0.05) higher for TPA (0.88) and AA (0.86) than for PROCAM (0.85) and SCORE (0.82). Net reclassification improvement (NRI) with AA instead of chronological age was 21±5% for PROCAM (p=0.00001) and was 49±7% for SCORE (p=0.0000004). Cox proportional-hazards regression with BMI, SMOKE, PROCAM, SCORE, FRAMINGHAM, TPA and AA was significant (p<0.01) for SMOKE (Wald 6.4), FRAMINGHAM (Wald 33.1), TPA (Wald 8.0) and AA (Wald 37.0). AA 10 year higher than chronological age was associated with a ASCVD risk of 22% in 10 years.
TPA and AA improved PROCAM and SCORE regarding diagnostic accuracy (AUC), reclassification index (NRI) and event-free survival (COX regression). Our study supports the Class IIa ESC 2019 recommendation for the assessment of ASCVD risk, “which should be considered as a risk modifier in individuals at low or moderate risk”.