Abundant scoring systems are available to assess the severity of coronary artery disease (CAD) and its intervention. However, the majority of them require advanced technologies. CHA2DS2-VASc-HSF is a novel and simple risk scoring, easily used for screening in primary care level. We hypothesize that CHA2DS2-VASc-HSF is predictive for severe CAD and indicative for coronary artery bypass grafting (CABG). Additionally, we compared its predictive value with CHA2DS2 and CHA2DS2-VASc score. A total of 210 consecutive patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score. Severe CAD is defined as Gensini Score >20. CABG indication was defined based on Class I recommendation from the American Heart Association (AHA). Statistical analyses were done using SPSS 25.0. Receiver operating characteristic (ROC) curve analysis showed the CHA2DS2 score (AUC [Area Under the Curve], 0.630; 95% CI, 0.555–0.706; p = 0.001), CHA2DS2-VASc score (AUC, 0.680; 95% CI, 0.608–0.752; p=0.000), and CHA2DS2-VASc-HSF score (AUC, 0.785; 95% CI, 0.723–0.846; p=0.000) were predictive of severe CAD. CHA2DS2-VASc-HSF score (AUC, 0.841; 95% CI, 0.711–0.971; p=0.00) were predictive of CABG indication. The CHA2DS2-VASc-HSF score provides the highest predictive value for severe CAD and CABG indication compared to the CHA2DS2 and CHA2DS2-VASc score, suggesting that CHA2DS2-VASc-HSF score may be used in primary care settings to suggest referral for coronary angiography and predict CABG possibilities.

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score. AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score. MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1. RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD. CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist.

Studies had reported an increasing trend of coronary artery disease (CAD) cases in the navy population. However, the severity of the CAD among different navy ranks is yet to be studied. The Gensini scoring system is a popular and developed objective method to quantify the CAD severity through the coronary angiographic findings. In this retrospective cross-sectional study, researchers enrolled 171 patients referred to the Indonesian Navy Hospital of Dr. Ramelan who underwent elective coronary angiography between January 2019 and June 2019. Researchers divided the study population into five groups of civilians, enlisted, noncommissioned officers, new commissioned officers and middle-rank officers. Post-hoc least significant difference (LSD) test showed the average Gensini Score of civilian (41.54 ± 48.06) is higher than enlisted (13.37 ± 26.25; p=0.031), new-commissioned officers (13.21 ± 26.76; p=0.020), and middle-rank officers (21.23 ± 33.17; p=0.017), but not for non-commissioned officers (45.61 ± 42.62; p=0.657). Non-commissioned officers have a significantly higher Gensini Score than enlisted (p=0.027), new-commissioned officers (p=0.019) and middle-rank officers (p=0.023). This study concludes that the majority of Indonesian Navy personnel had a lower Gensini Score compared to civilians but not for non-commissioned officers. This study suggests that civilian and non-commissioned officers may have a higher risk of developing severe CAD.

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