P01 Reclassifying cardiovascular risk using fat attenuation index (FAI) by CaRi-Heart® medical device in patients assessed with QRISK3 and CAD-RADS 2.0

• Published in: Heart (British Cardiac Society) Vol. 109; no. Suppl 4; pp. A2 - A3
• Main Authors: Fulukwe, C, Murphy, D, Graby, J, Khavandi, A, Shirodaria, C, Antoniades, C, Rodrigues, JCL
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.10.2023
• Subjects: Cardiovascular disease; Coronary vessels; Pharmacists; United Kingdom > UK
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-BSCI.5

IntroductionFat attenuation index (FAI) is a novel biomarker assessing coronary inflammation. In a non-UK population this inflammatory burden increased the relative risk of a fatal cardiac event. We describe risk reclassification by FAI versus QRISK3 (NICE recommended risk prediction tool) and the coronary artery disease reporting and data systems (CAD-RADS-2.0), the UK CTCA reporting standard.MethodsConsenting patients (ORFAN study) undergoing CTCA (Jan-2022 to April-2023) were included. QRISK3 <10% was classed as low-risk, 10-20% intermediate and ≥20% high-risk. A weighted FAI-score ≤75th percentile for the left anterior descending (LAD) or right coronary artery (RCA) and <95th for the left circumflex artery (Lcx) defined low-risk; 76-89th for LAD or RCA and ≥95th for Lcx defined high-risk; and ≥90th percentile for the LAD or RCA defined very high-risk.Results128 patients were included, mean age 61±8, 92 (72%) male. FAI re-classified 81% (36/44) of high-risk and 25% (5/20) of low-risk QRISK3 cases to low-risk and very high-risk respectively. Net reclassification -1.08. 20% (3/15) of CAD-RADS1 were very high-risk by FAI. A diagnostic odds ratio (DOR) for very high-risk (FAI) following CTCA was 1.8 (0.4-7.1;P=.4), 0.95 (0.3-2.7;P=.9), 0.5 (0.1-2;P=.3) and 1.3 (0.4-4;P=.7) for CAD-RADS 1-4 respectively and 0.6 (0.2-2.2;P=.4), 1.4 (0.4-4;P=.5), 1.2 (0.4-4;P=.8) and 0.7 (0.08-6;P=.8) for plaque grades 1-4 respectively. High-risk plaque had a DOR of 3.7 (1.2-10.8;P=.02).Conclusions25% of low-risk QRISK3 and 20% of CAD-RADS1 cases were reclassified as very high-risk following FAI analysis. High-risk plaque features were associated with very high-risk FAI, however CAD-RADS-2.0 severity grade was not.