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

Abstract: Background: Coronary 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. Methods: We 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). Results: The 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. Conclusions: We 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study received funding from: Swedish Heart-Lung Foundation, Knut and Alice Wallenberg Foundation, Swedish Research Council and VINNOVA (Sweden's Innovation agency), University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Stockholm county council, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, Uppsala University and University Hospital. Funding was also received from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-718851). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: SCAPIS was approved by the ethics committee in Umea, Sweden (number 2010-228-31M), all participants gave written informed consent, and the study protocols adhered to the declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Due to the nature of the sensitive personal data and study materials they cannot be made freely available. However, by contacting the corresponding author or study organization (www.scapis.org), procedures for sharing data, analytic methods, and study materials for reproducing the results or replicating the procedure can be arranged following Swedish legislation.