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Value of Coronary Calcium Score for risk reclassification in elderly with high or very high cardiovascular risk
Session:
Sessão de Posters 16 - Mapeamento do risco: dos scores ao cálcio
Speaker:
Mariana S Silva
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana S Silva; Carlos Oliveira Costa; Inês Amorim Cruz; Tiago Filipe Aguiar; Simão Almeida Carvalho; Ana Faustino; Mesquita Bastos
Abstract
<p>Introduction: SCORE2-OP is the recommended tool for estimating 10-year cardiovascular risk (CVR) in the elderly. Coronary calcium score (CS) is a direct marker of atherosclerotic burden and a well-established method for reclassifying CVR in patients (P) with moderate CVR or low CVR with additional risk factors but is not recommended in high or very-high CVR categories. </p> <p>Objectives: To evaluate the relationship between the SCORE2-OP and the CS in older P and to compare its usefulness in predicting obstructive coronary artery disease (CAD). </p> <p>Methods: Cross-sectional observational study including 97 consecutive P≥75 years undergoing coronary CT angiography (CTA) for evaluation of stable chest pain between 2020–2025 (78 years [75–88], 51.5% men, 85.6% with hypertension, 27.8% with diabetes, 86.6% with dyslipidaemia, median CS 303 [0-5322] and mean Score2-OP 18.29±6.69. SCORE2-OP was calculated and categorised by risk groups. Clinical data, demographics, CVR factors, analytical parameters, CS and obstructive CAD by CTA (≥50% stenosis) were evaluated. CS was stratified by percentiles (Hoff et al. Am J Cardiol. 2001.).The relationship between SCORE2-OP and CS was evaluated, and their discriminatory acuity for prediction of obstructive CAD in CTA was assessed by ROC curve analysis. </p> <p>Results: According to SCORE2-OP, all patients were classified as either high (35.4%) or very high (64.6%). Regarding CS, 18.6% were in the <25th percentile, including 5.2% with CS=0, while 39.2% were in the >75th percentile. Although very-high-risk SCORE2-OP P had higher CS values (Kruskal–Wallis p=0.015), no correlation was found between the SCORE2-OP and CS (r=0.165, p=0.138), which remained non-significant when evaluated across CS percentiles. By ROC curve analysis (Figure 1), SCORE2-OP showed no discriminative ability to identify obstructive CAD (AUC=0.403, CI 95% 0.235–0.570; p=0.253), while CS had a good performance (AUC=0.740, CI 95% 0.615-0.865; p<0.001). </p> <p>Conclusions: SCORE2-OP showed relevant discordance with CS values, only reflecting correctly atherosclerotic burden in 39.2% of P, and demonstrating no ability to identify obstructive CAD. Therefore, in older P, CS has superior performance for CVR stratification and is useful for risk reclassification even in SCORE2-OP high or very-high CVR categories, particularly to reclassify P to lower-risk groups and support treatment de-escalation in frequently polymedicated individuals.</p>
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