Multi-Ethnic Study of Atherosclerosis (MESA) score compared to the Pooled Cohort Equations (PCE) score for cardiovascular risk assessment

Introduction. The current risk categorization of cardiovascular (CV) disease based on the Pooled Cohort Equations Risk (PCE) broadened the scope of candidates eligible for statin therapy. Coronary artery calcium score (CCS) identifies those who are most likely to benefit from statin therapy for primary prevention. The Multi-Ethnic Study of Atherosclerosis (MESA) score is a new and the the first, that includes CCS for cardiac risk assessment.

Aim: To find whether the MESA score can better predicts CV events than the PCE score and better allocates asymptomatic subjects for statin treatment

Methods.: 632 consecutive subjects free of CV disease, mean age 56 ±7 years, 84% male, underwent clinical evaluation and CCS measuring. PCE and MESA risk scores were calculated for each subject. Patients were divided according to the 4 PCE categories of 10 years CV risk, and further analyzed according to a higher or lower risk groups than 7.5% , the cutoff above which statin is definitely indicated.

Results. During mean follow-up of 6.5 ± 3.3 years, 54 subjects experienced a first CV event. Those with MESA risk score ≤ 7.5% had a favorable outcome even when the PCE indicated a risk of >7.5%. The MESA risk improves the discrimination, ROC curves C-statistics increased from 0.653 for the PCE risk to 0.770. 84% (99/118) of those with borderline risk (5 to ≤7.5% ) according to the PCE score, were re-allocated by the MESA risk into an higher (>7.5%) or lower risk category (<5%).

Conclusion : The MESA risk score better predicts CV events than the PCE score in asymptomatic , and contributes to better allocate them to statin treatment.