Background/Purpose: Systemic sclerosis (SSc) is associated with both micro- and macrovascular damage, increasing cardiovascular (CV) risk. The SCORE2 algorithm estimates CV event risk in the general population but may underestimate it in SSc. Nailfold capillaroscopy (NFC) detects microangiopathy typical of SSc, which may improve CV risk prediction in this population.To evaluate the predictive value of NFC findings for CV events and assess whether incorporating these into the SCORE2/SCORE2-OP algorithms improves risk stratification.

Methods: We conducted a multicenter retrospective study of 276 SSc patients without prior CV events. SCORE2 was applied to patients aged 40–69, and SCORE2-OP to those ≥70. NFC was performed at diagnosis. A Cox regression identified NFC variables associated with incident MCE during follow-up. Based on these results, a modified SCORE2 was calculated by applying hazard ratios (HRs) of the baseline NFC findings, to the original SCORE2 score. ROC curves assessed the discrimination of original versus the modified model. Patients were categorized into standard risk levels (low, moderate, high, very high), and the Net Reclassification Index (NRI) was calculated.

Results: Over a median follow-up of 9.5 years, 45 patients (16.3%) experienced a CV event. Baseline characteristics are summarized in Table 1. Hemorrhages (p = 0.002) and avascular areas (p < 0.001) at diagnosis were significantly associated with subsequent CV events. In multivariate Cox analysis, hemorrhages showed an independent protective effect (HR = 0.333, p = 0.01), while avascular areas were independently associated with increased risk (HR = 2.238, p = 0.034) (Table 2).The modified SCORE2 showed improved discrimination (AUC 0.767) compared to the original (AUC 0.680) (Figure 1). At the optimal threshold (1.83%), the modified SCORE2 yielded a sensitivity of 85.2% and specificity of 58.4%, versus 74.1% and 59.4% for the original model.Among patients with CV events, 33% were correctly reclassified to higher risk and 7% incorrectly to lower risk. Among non-event patients, 3% were correctly reclassified to lower risk and 5% incorrectly to higher risk. The total NRI was +0.239, indicating improved net reclassification.

Conclusion: Adjusting the SCORE2 algorithm using NFC findings at the time of diagnosis improves cardiovascular risk prediction in patients with systemic sclerosis. Avascular areas confer increased risk, while hemorrhages appear protective. These microvascular markers may support more personalized cardiovascular prevention strategies in this high-risk population.

Table 1: Demographic, clinical and laboratory data from the cohort

Table 2. Multivariate Cox-regression analysis of predictors for cardiovascular events

SCORE2 and SCORE2 modified by nailfold capillaroscopy

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nailfold-capillaroscopy-improves-cardiovascular-risk-stratification-in-systemic-sclerosis-an-adjustment-to-the-score2-algorithm/