CorCal Outcomes — Effectiveness of a Proactive Cardiovascular Primary Prevention Strategy, With or Without the Use of Coronary Calcium Screening, in Preventing Future Major Adverse Cardiac Events

CorCal

Patient / Population Intervention / Exposure Comparison Outcome

In 5,772 statin-naïve adults in primary prevention, coronary calcium score-guided statin therapy was not non-inferior to risk score-guided statin therapy for major adverse cardiovascular events.

N

5,772patients

Design

Single health-system (Intermountain Health, Utah), open-label, 1:1 randomised non-inferiority trial; patients identified by EHR query and randomly invited; primary analysis by modified per-protocol approach (all who completed baseline testing and received a statin recommendation, n = 5,329); event follow-up up to 5 years via EHR; projected completion second quarter 2026

Endpoint

MACE — composite of all-cause mortality, myocardial infarction, stroke and revascularisation (coronary, carotid and peripheral)

Relevance

2Important — one of several pillars.

ResultOver 4.2 years, major adverse cardiovascular events occurred in 2.7% of both groups and the non-inferiority criterion was not met (HR 0.99, 95% CI 0.71–1.38; P = 0.045 for non-inferiority). Patients in the risk-score arm were recommended a statin more than three times as often, while adherence was far higher when the recommendation followed a calcium score (62% vs 23%).

Muhlestein JB, et al. Presented at ESC Congress 2026, Hot Line 11, 31 August.

Discussion & critique

Two ways of deciding who starts a statin produced the same 2.7% event rate over four years, which is the answer the calcium camp wanted — except the trial was built as a non-inferiority study and, on the investigators' own reading, missed its criterion, because 2.7% in a primary-prevention cohort leaves too few events to exclude a meaningful difference. The interesting number is behavioural: the risk equation recommended statins three times as often, the calcium score got people to take them, 62% against 23%. A scan that treats fewer people better may end up in the same place, but this trial cannot show that it does.