Pre-screening to guide coronary artery calcium scoring for early identification of high-risk individuals in the general population

Aims To evaluate the ability of Systematic COronary Risk Estimation 2 (SCORE2) and other pre-screening methods to identify individuals with high coronary artery calcium score (CACS) in the general population. Methods and results Computed tomography-based CACS quantification was performed in 6530 individuals aged 45 years or older from the general population. Various pre-screening methods to guide referral for CACS were evaluated. Miss rates for high CACS (CACS >= 300 and >= 100) were evaluated for various pre-screening methods: moderate (>= 5%) and high (>= 10%) SCORE2 risk, any traditional coronary artery disease (CAD) risk factor, any Risk Or Benefit IN Screening for CArdiovascular Disease (ROBINSCA) risk factor, and moderately (>3 mg/24 h) increased urine albumin excretion (UAE). Out of 6530 participants, 643 (9.8%) had CACS >= 300 and 1236 (18.9%) had CACS >= 100. For CACS >= 300 and CACS >= 100, miss rate was 32 and 41% for pre-screening by moderate (>= 5%) SCORE2 risk and 81 and 87% for high (>= 10%) SCORE2 risk, respectively. For CACS >= 300 and CACS >= 100, miss rate was 8 and 11% for pre-screening by at least one CAD risk factor, 24 and 25% for at least one ROBINSCA risk factor, and 67 and 67% for moderately increased UAE, respectively. Conclusion Many individuals with high CACS in the general population are left unidentified when only performing CACS in case of at least moderate (>= 5%) SCORE2, which closely resembles current clinical practice. Less stringent pre-screening by presence of at least one CAD risk factor to guide CACS identifies more individuals with high CACS and could improve CAD prevention.