Nailfold capillaroscopy improves cardiovascular risk stratification in SSc: an adjustment of the SCORE2 algorithm.

Late NFC pattern was independently associated with increased risk of major cardiovascular events in SSc patients.

• Adjusted hazard ratio of 4.056 (P = 0.002) in multivariable Cox regression models
• Study included 276 patients with SSc in a retrospective multicentre design
• Median follow-up was 9.5 years
• 45 patients (16.3%) experienced a major cardiovascular event (MCE) during follow-up

Avascular areas on nailfold capillaroscopy were independently associated with increased risk of major cardiovascular events.

• Adjusted hazard ratio of 2.631 (P = 0.039) in multivariable Cox regression models
• NFC was assessed at diagnosis and baseline 10-year CV risk was estimated using SCORE2 or SCORE2-OP
• Cox regression was used to identify NFC variables associated with MCEs

Microhaemorrhages on nailfold capillaroscopy were associated with reduced risk of major cardiovascular events.

• Adjusted hazard ratio of 0.345 (P = 0.017) in multivariable Cox regression models
• This finding suggests a protective or inversely associated relationship between microhaemorrhages and MCEs
• Finding was identified through multivariable Cox regression analysis

Original SCORE2 showed only modest discrimination for incident major cardiovascular events in SSc patients.

• AUC of 0.687 (95% CI 0.574–0.801) for original SCORE2
• This supports the premise that SCORE2 underestimates CV risk in systemic autoimmune diseases such as SSc
• Discrimination was assessed over a median follow-up of 9.5 years in 276 SSc patients

NFC-modified SCORE2 models significantly improved cardiovascular risk discrimination compared to the original SCORE2.

• NFC-findings model achieved AUC of 0.784 (95% CI 0.674–0.894), P < 0.05 vs original SCORE2
• NFC-pattern model achieved AUC of 0.764 (95% CI 0.654–0.875), P < 0.05 vs original SCORE2
• Both models showed consistent gains in Harrell's C-index
• Bootstrap internal validation was performed to confirm model performance
• NFC-modified models were derived by applying adjusted hazard ratios of NFC variables to SCORE2

Risk reclassification analyses demonstrated improved classification of patients who experienced major cardiovascular events using NFC-modified models.

• Categorical net reclassification index (NRI) was 0.31 for the NFC-findings model
• Categorical net reclassification index (NRI) was 0.36 for the NFC-pattern model
• Reclassification analyses specifically highlighted improved classification of patients with MCEs