A self-report tool for identification of individuals with coronary atherosclerosis – The Swedish CArdioPulmonary BioImage Study

Abstract

AbstractBackgroundCoronary atherosclerosis detected by imaging is a marker of elevated cardiovascular risk. However, imaging involves large resources and exposure to radiation. The aim was, therefore, to test whether non-imaging data, specifically data that can be self-reported, could be used to identify individuals with moderate to severe coronary atherosclerosis.MethodsWe used data from the population based Swedish CArdioPulmonary BioImage Study (SCAPIS) in individuals with coronary computed tomography angiography (CCTA, n=25,182) and coronary artery calcification score (CACS, n=28,701), aged 50-64 years without previous ischemic heart disease. We developed a risk prediction tool utilizing variables that could be assessed from home (a so-called self-report tool). For comparison, we also developed a tool utilizing variables from laboratory tests, physical examinations and self-report (a so-called clinical tool) and evaluated both models using receiver operating characteristic curve analysis, external validation, and bench-marked against factors in the Pooled Cohort Equation (PCE).ResultsThe self-report tool (n=14 variables) and the clinical tool (n=23 variables) showed high-to-excellent discriminative ability to identify SIS ≥4 (AUC 0.79 and 0.80, respectively) and significantly better than PCE (AUC 0.76, p<0.001). The tools showed a larger net benefit in clinical decision making at relevant threshold probabilities. The self-report tool identified 65% of all individuals with SIS ≥4 in the top 30% of the highest-risk individuals. Tools developed for CACS ≥100 performed similarly.ConclusionsWe have developed a self-report tool which effectively identifies individuals with moderate to severe coronary atherosclerosis. The self-report tool may serve as pre-screening tool towards a cost-effective CT-based screening program for high-risk individuals.Clinical PerspectiveWhat Is New?We have developed a self-report tool which with a good-to-excellent discriminative ability identifies individuals with moderate to severe coronary atherosclerosis.The self-report tool can be executed from home and has a similar performance to a clinical tool requiring a clinical visit involving blood tests and physical examination.What Are the Clinical Implications?The self-report tool could serve as an initial step towards a cost-effective screening program to identify high-risk individuals or used to identify individuals who would benefit from further risk refinement by cardiac imaging.