CAC Scoring Can Identify High-Risk Adults Who Could Benefit From Anticoagulation Therapy – Consultant360

Coronary artery calcium (CAC) scoring can accurately identify high-risk adults who may benefit from low-dose rivaroxaban for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), according to a new analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study.

To reach this conclusion, the researchers modeled expected outcomes of low-dose rivaroxaban in 5196 participants in the MESA study who were not already receiving antiplatelet or anticoagulant therapy.

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By applying relative risk ratios from the COMPASS trial to absolute MESA event rates, the researchers estimated the number needed to treat to avoid a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The researchers also estimated the number needed to harm to cause 1 hospitalized bleed. The estimates were then stratified by the calculated ASCVD risk and baseline CAC score.

Among the participants who had a CAC score of 300 or more (moderate to high risk), there was a crude ASCVD event rate of 20 per 1000 patient-years. According to the study authors, the COMPASS control-arm yielded comparable results.

While CAC was independently associated with the composite ASCVD outcome, it was not independently associated with adjusted hazard ratio for hospitalized major bleeding.

Further, among participants with a CAC score of 100 to 299 (low to moderate risk), the predicted 5-year number needed to treat was 75, with a number needed to harm value of 252. Meanwhile, among participants with a CAC score of 300 or more (moderate to high risk), the predicted 5-year number needed to treat was 45, with a number needed to harm value of 98.

CAC helps to distinguish estimated ASCVD benefit from estimated bleeding harm, thereby identifying very high-risk primary prevention adults without established cardiovascular disease who may derive net-benefit from low-dose rivaroxaban, the researchers concluded.

Colleen Murphy

Reference:

Arps K, Al Rifai M, Blaha MJ, et al. Usefulness of coronary artery calcium to identify adults of sufficiently high risk for atherothrombotic cardiovascular events to consider low-dose rivaroxaban thromboprophylaxis (from MESA). Am J Cardiol. 2019;124(8):1198-1206. doi:10.1016/j.amjcard.2019.07.016.

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CAC Scoring Can Identify High-Risk Adults Who Could Benefit From Anticoagulation Therapy - Consultant360