Physicians' Academy for Cardiovascular Education

CAC helps to identify people who will benefit from NOAC for primary prevention of ASCVD

Usefulness of Coronary Artery Calcium to Identify Adults of Sufficiently High Risk for Atherothrombotic Cardiovascular Events to Consider Low-Dose Rivaroxaban Thromboprophylaxis (From MESA)

Literature - Arps K, Rifai MA, Blaha MJ, et al., - Am J Cardiol 2019, doi: 10.1016/j.amjcard.2019.07.016

Introduction and methods

The COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulant Strategies) demonstrated a role for low-dose rivaroxaban in patients with stable ischemic heart disease [1]. Most myocardial infarctions, up to 70%, occurs in people without established atherosclerotic CVD (ASCVD) [2]. The COMPASS strategy can potentially be beneficial in those in the primary prevention setting with comparable atherosclerotic risk as in the COMPASS trial [3-5]. Because anticoagulation therapy is associated with harm (increased risk of bleeding), appropriate risk stratification is important in primary prevention setting.

This study examined whether individualized risk assessment, using coronary calcium score (CAC) and traditional risk estimation, identified a high-risk population, who benefit from low-dose rivaroxaban for primary ASCVD prevention.

The effect of low dose rivaroxaban was modeled in the Multi-Ethnic Study of Atherosclerosis (MESA). The MESA is a prospective, multicenter study consisting of a multi-ethnic population free of clinical ASCVD at baseline, not using antiplatelet or anticoagulant therapy. The MESA cohort included 6814 participants between July 2000 and September 2002. 10-year ASCVD risk was calculated using the Pooled Cohort Equations (PCE) [6] and CAC was calculated by the Agatston method. ASCVD was a composite of CV death, non-fatal MI or non-fatal stroke. Relative risk ratios from COMPASS were applied to absolute event rates in the MESA cohort to calculate NNT and NNH, stratified by ASCVD risk and baseline CAC.

Main results


Assessing atherosclerotic burden by CAC in people without established ASCVD, in addition to 10-year ASCVD risk calculation, helps to identify a high-risk population who will benefit from low dose rivaroxaban.


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Find this article online at Am J Cardiol

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