Abstract 16751: BioImage Study: Reclassification and Discrimination by Novel Biomarker Panel (CardioSCORE), Coronary Calcium Score, Carotid Intima-Media Thickness&Plaque Burden in Asymptomatic Individuals

Abstract

Aim: We aimed to assess the improvement of prediction of major adverse cardiovascular events (MACE) upon addition of a novel panel of 7 plasma proteins ('CardioSCORE'), coronary artery calcium (CAC) by computed tomography (CT), carotid intima-media thickness (IMT) and plaque burden by ultrasound in the BioImage Study, an observational study designed to detect and evaluate novel imaging and circulating biomarkers as predictors for near-term atherothrombotic events in asymptomatic at-risk subjects aged ≥55 years.

Methods: Reclassification statistics and discrimination improvement analyses were used to compare the incremental predictive value of the addition of each biomarker to a traditional risk factor-based model (age, gender, total cholesterol, HDL-C, SBP, DBP, diabetes, smoking status).

Results: The study population consisted of 6808 individuals (69±6 years, 44% males). At a median follow-up of 2.5 years, 292 (4.3%) MACE were noted. In Cox proportional hazards models adjusted for traditional risk factors, log CAC was associated with increased hazards for MACE (HR: 1.18 per log unit, 95% CI 1.11-1.25). The respective HRs were 1.32per score unit (95% CI 1.21-1.44) for increasing CardioSCORE and 1.63 per log unit (95% CI 1.31-2.05) for carotid plaque burden. As shown in the table, addition of CardioSCORE, carotid plaque burden,or CAC to traditional risk factors provided the highest net reclassification improvement (NRI) and discrimination assessed by the area under the receiver operating characteristic curve (AUROC) and the integrated discrimination improvement (IDI).

Conclusion: In this study of asymptomatic at-risk subjects, a novel biomarker panel (CardioSCORE), carotid plaque burden and CAC substantially improved risk reclassification for near-term MACE. Considering the ease of testing, assessment of CardioSCORE as well as carotid plaque burden appear promising as potential novel predictors for further MACE.