BackgroundCoronary heart disease (CHD) is prevalent in the United States, highlighting the need for accurate risk prediction to inform primary prevention strategies. While multivariate risk models like the Framingham Risk Score and ACC/AHA Pooled Cohort Equations are commonly utilized, novel risk markers, such as the coronary artery calcium score (CACS) and polygenic risk score (PRS), are increasingly gaining recognition.ObjectivesThis study aimed to compare the diagnostic utility of CACS and CAD PRS, both individually and in combination, for predicting major adverse cardiovascular events (MACE).MethodsWe conducted a retrospective analysis of a cohort comprising 1,380 predominantly Caucasian participants from the Sanford Health System. CAD PRS was constructed using genetic variants, while CACS was assessed via cardiac computed tomography (CT). Statistical analyses evaluated the relationship between each modality and MACE.ResultsBoth CAD PRS and CACS were significantly associated with future MACE. Following the adjustment for covariates, the area under the curve (AUC) for both the CACS and PRS models was comparable, indicating similar predictive capabilities for MACE. However, the combination of CAD PRS with CACS significantly enhanced predictive accuracy, outperforming either modality alone.ConclusionsThis study underscores the value of integrating CACS and CAD PRS in predicting MACE. The synergistic effect of CAD PRS combined with CACS markedly improves predictive power. Further research and prospective studies are necessary to validate these findings and assess their clinical implications. Investigating the interactions between PRS and CACS will be crucial for refining cardiovascular risk prediction and optimizing prevention strategies.

Introduction: In multiple recent studies, a higher coronary artery calcium score (CACS) has been associated with a higher risk of MACE and all-cause mortality. The relationship between coronary artery calcium (CAC) and the incidence of stroke is poorly defined. Method: Patients were obtained from the Sanford heart screening program from April 25, 2011 through June 23, 2023. The sample was limited to only those who underwent a CACS. A high CACS was deemed as anything greater than or equal to 300, whereas anything lower was identified as non-high CACS. The odds ratio was calculated via multiple logistic regression to analyze the data. Results: A total of 33249 patients with CACS were analyzed in this study. The average age of the patients is 56.19 (SD =9.97) and 46% of them are male. Among all the patients in the study, 3529 had a high CACS, of which 399 of them had stroke (11.3%). Our study shows that there is a positive effect between a high CACS and the incidence of stroke. The odds of having stroke are predicted to be 1.95 times larger in patients with high CACS (P-value < 0.001). In comparison to the patients who smoke frequently, the odds of developing a stroke shrink by a factor of about 0.53 and 0.48 for patients who do not smoke (P-value < 0.001) and patients who smoke occasionally (P-value=0.003), respectively. Furthermore, a five-year increase in age results in a 32% increase in odds of developing a stroke for patients with CACS less than 300 (P-value < 0.001), and a 17% increase in odds of developing a stroke for patients with high CACS (P-value = 0.006). However, for each additional year after CACS testing, the odds of stroke decreased by 18%, for patients with CACS less than 300 (P-value < 0.001), and 27%, for patients with high CACS (P-value < 0.001), likely due to interventions done. Conclusion: Our study showed that a high coronary artery calcium score predicts an increased incidence of stroke in our patient population.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a complex disease process, and an early diagnosis of high-risk patients will decrease morbidity and mortality. In our study, we evaluated Coronary Artery Disease Polygenic Risk Score (CAD PRS) and Coronary Artery Calcium Score (CACS) and their combination in the prediction of ASCVD, represented by peripheral vascular disease, aortic sclerosis, severe aortic stenosis, and stroke. Method: Our population was individuals enrolled in the Sanford Heart Screening Program and genotyped using the Illumina Global Screening Array version 1. CAD PRS was calculated using a literature-derived list of 180 single nucleotide polymorphisms (SNP). Patients were classified into two groups based on CAD PRS: High PRS (>=85 th percentile) or low/intermediate PRS (<85 th percentile). CACS was classified as high risk with a value of ≥ 300 and a non-high score when <300. We used hierarchical logistic regression to assess CAD PRS, CACS, and their combination in predicting ASCVD. Results: In a sample of 689 patients, CACS was associated with sclerosis (OR=2.29 [1.18, 4.30], p<.05), aortic stenosis (OR=10.0 [2.14, 70.6], p<.01), PVD (OR=2.52 [1.23, 4.97], p<.01) but not a stroke (OR=1.63 [0.62, 3.87], p=.3). A high PRS was shown not to be significantly associated with aortic sclerosis (OR=1.23 [0.52, 2.60], p=.60), PVD (OR=1.09 [0.40, 2.52], p=.8), or stroke (OR=1.5 [0.49, 3.84], p=.4), but was marginally associated with aortic stenosis (OR=4.31 [0.84, 19.8], p=.058). When holding a high CACS constant, a high PRS failed to show any significant hierarchical utility in predicting aortic stenosis (OR=3.10 [0.59, 14.7], p=.20). Conclusion: The combination of high CAD PRS to high CACS was not clinically significant in improving predictive value for atherosclerotic cardiovascular diseases, although was noted to be marginally significant for aortic stenosis. Increasing sample size might increase the power and show clinical significance in future assessment

Introduction: Coronary artery calcium (CAC) is well-validated for cardiovascular risk stratification. There are well-known gender differences in the presentation, diagnosis, and management of cardiac diseases that have been extensively studied in the past. To date, there have not been extensive studies to look at the differential effect of CAC score on major adverse cardiac events (MACE; defined as death, MI, stroke, or coronary revascularization) amongst men and women. The objective of our study is to look at this aspect. Methods/Results: Data were analyzed on a group of 1,380 patients who had participated in both the Sanford Health Heart Screen Program and the Sanford Health Preemptive Genomic Screening Program. These patients had their heart screen between 2011 and 2021 and their genetic testing between 2018-2022. Patients consented to both forms of screening independently, and the results were analyzed by means of a retrospective review. While other genetic factors were excluded from this study, we separated patients by sex. This sample had 64% female and 36% male. 10% of males had a MACE event and 4.9% of females had a MACE event. Males had higher levels of CAC (M=249.55, SD=550.41) compared to that of females (M=57.97, SD=190.5). The correlation between CAC and MACE was higher for males (r=0.33, p<0.01) than it was for females (r=0.17, p<0.05), Zou’s CI [.06, .26]. Conclusion: Males, overall had a higher level of CAC score compared to females. The correlation between the CAC score and MACE was also higher for males, as compared to females.

Background: The polygenic risk score for coronary artery disease (CAD PRS) is an emerging CAD risk assessment tool. It is unclear if it improves predictive value for major adverse cardiovascular events (MACE). This study aims to investigate the value of PRS as predictor for MACE. Methods: Patients who had coronary calcium score (CAC) within the Sanford Heart Screening Program were enrolled in the study from 2011-2021. They were genotyped using Illumina Global Screening Array version 1. PRS was calculated using a literature derived list of 180 single nucleotide polymorphisms. Patients were classified into 3 groups based on CAD PRS: high PRS (> 85 th percentile), moderate PRS (15 th to 85 th percentile) or low PRS (<15 th percentile). MACE was defined as the composite of death, myocardial infarction, coronary revascularization and heart failure hospitalization. Results: A total of 1,380 patients with mean age of 57.76± 9.76 were analyzed of which 6.6% had MACE. Chi-square test revealed a significant relationship between PRS (low, moderate, high) and a future MACE event, [X 2 (N=1380) = 9.9,p < .01]. Post-hoc testing showed that those with high PRS(standardized residuals = 3.14, p < .01) were more likely to have a future MACE event than those with a moderate (standardized residuals =1.59, p=.68) or low PRS (standardized residuals =1.11, p = 1) (Figure 1). Conclusions: This study shows that high CAD PRS has an added value in predicting future MACE in general population as represented in our Sanford Heart Screening Program.

Introduction: Coronary artery calcium (CAC) score is a well-established tool for risk assessment of coronary artery disease (CAD). Alternatively, CAD polygenic risk score (PRS) is an emerging modality for assessing risk of CAD. Our study aims to compare the sensitivity and specificity of the above scores in predicting major adverse cardiovascular events (MACE). Hypothesis: CAD PRS is a better predictor of MACE than CAC score. Methods: Adult patients had CAD PRS, CAC and baseline characteristics documented through the Sanford Heart Screening Program from 2011 to 2021. Incidence of MACE, defined as myocardial infarction, stroke, death, and revascularization, was analyzed. Chi-squared tests were used to examine the impact of stratified risk scores and MACE. A logistic regression model was trained on 70% of the data to assess prediction accuracy on 30% of the data. Results: A total of 1,380 patients were analyzed. Mean age was 63, with female (65%) and Caucasian (99%) predominance. The prevalence of diabetes mellitus, hyperlipidemia, and hypertension was 8%, 32%, and 7%, respectively. The incidence of MACE was 6.6%. Patients with MACE had higher CAC (527.1±856.2 vs. 98.3±294.3) and CAD PRS (15.5±.62 vs. 15.24±.61). Sensitivity and specificity are represented by the receiver operating characteristic curve, which was used to assess prediction accuracy whereby area under the curve (AUC) was used as a measure of fit ranging from 0 to 1. The curves showed that CAC had better AUC than PRS (Figure 1). Conclusions: In our study CAD PRS failed to be a better predictor of MACE compared to CAC score.

INTRODUCTION:Rural sites provide management challenges for ST-elevation myocardial infarction (STEMI) patients. The impact of emergency medical service (EMS) training and institutional volume experience on STEMI outcomes was examined.METHODS:All STEMI patients transferred to Sanford from 32 sites in rural South Dakota from 2010-2019 were analyzed. "Time to electrocardiogram (EKG)" (TEKG) and "Time from EKG to Thrombolytics" (TThrom) were calculated. Sites were compared based on EMS training (advanced life support (ALS) vs. basic life support (BLS)) and institutional volume experience (less than or equal to five vs. greater than five STEMI).RESULTS:514 STEMI patients from 32 sites in South Dakota were analyzed. Average TEKG was 20 (±15) and 14 (±10) minutes for ALS and BLS trained services, respectively (p=0.25). More experienced sites had an average TEKG of 26 (±15) minutes, while sites with ≤ five STEMI patients had an average time of 15 (±13) minutes. TThrom did not differ significantly between sites based on our metrics.CONCLUSION:The present study concludes that EMS provider training (BLS vs ALS) and institutional volume experience do not significantly impact patient-related outcomes when treating STEMI patients. This result is possibly attributed to increased educational efforts for rural health care providers in general and the establishment of the South Dakota statewide STEMI Network "Mission: Lifeline" which standardized STEMI care and improved connectivity between remote responders and the larger PCI-capable facilities.

Objective: To study the use of CYP2C19 genotyping to guide P2Y(12) inhibitor selection to maximize efficacy, and attenuate risk in appropriate patients who underwent PCI for CAD. Methods: We performed a retrospective analysis of 868 patients with CAD who received CYP2C19 genotyping after PCI and changed P2Y(12) inhibitor based on the results. Patients were divided into two groups based on clopidogrel metabolizer status. Group Intermediate (IM) and poor metabolizers (PM). Group II: Ultra-rapid (UM), rapid (RM) and normal metabolizers (NM). Each group was then categorized to one of two treatment arms guided by CYP2C19 genotype. Category 1:IM/PM started on clopidogrel, switched to ticagrelor or prasugrel; 2:IM/PM started on ticagrelor/prasugrel, continued these medications; 3:UM/RM/NM started on ticagrelor/prasugrel, switched to clopidogrel; 4:UM/RM/NM started on clopidogrel, continued clopidogrel. Death due to cardiac causes, bleeding events, non-fatal MI, target vessel revascularization (TVR), and MACE in all four categories were considered at 1, 6 and 12 months. Results: We did not observe significant difference between phenotypes for MACE at 1 (p = 0.274), 6 (p = 0.387), and 12 months (p = 0.083). Death due to cardiac causes, MI, and bleeding events were not significant at 1, 6, and 12 months. There was no significant difference in TVR at 6 (p = 0.491), and 12 months (p = 0.423) except at 1 month (p = 0.012). Conclusion: CYP2C19 genotype-based intervention can be implemented effectively and reliably to guide selection of P2Y(12) inhibitor to optimize patient quality and safety when appropriate in post PCI patients. (C) 2021 Cardiological Society of India. Published by Elsevier B.V.

PURPOSE:To report a case of superior ophthalmic vein thrombosis (SOVT) and review the available literature to assess if anticoagulation is warranted in all cases of SOVT.OBSERVATIONS:The patient presented to an outside hospital facility with a severe headache involving the left frontal temporal area. This progressed to left-sided ptosis and facial droop. Magnetic resonance imaging revealed a left SOVT secondary to sphenoid sinusitis. Treatment was initiated with vancomycin and cefepime, and the patient was transferred to our tertiary care center for further management. Upon arrival at our facility, her symptoms had significantly improved compared to prior documented findings.CONCLUSIONS AND IMPORTANCE:Due to the rarity of SOVT, large clinical studies assessing the necessity of anticoagulation are not likely to be conducted. A review of the literature suggests the use of anticoagulation is determined on a case-by-case basis, taking into account symptom severity. Our case demonstrates that a resolution of symptoms is possible without anticoagulation. The decision to initiate anticoagulation will continue to require a clinician to perform a detailed physical examination to determine if the patient is responding to antibiotic treatment alone.