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Background Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina. Methods Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality. Results There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780). Conclusion Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality. Contribution Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.

Background In 2019, the World Health Organization (WHO) declared coronary artery disease (CAD) as the leading cause of death globally for the last 20 years. Early screening and detection (primary prevention) and intervention (secondary prevention) are necessary to curb CAD and major adverse cardiovascular event (MACE) prevalence. A scoping review to assess the current literature on using cardiac scoring systems to predict CAD and MACE was performed. Methods The research question ‘What is the literature on using cardiac scoring systems to predict CAD and MACE?’ was addressed. The updated Arksey and O’Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews methodologies were used. The search terms ‘coronary artery disease’ and ‘cardiac scoring systems’ and ‘major adverse cardiovascular events’ were used in the Boolean search on PubMed, ScienceDirect, MedLine and Cochrane Library. Results The final list consisted of 19 published English results after the year 2000. There were six results without participants (four clinical guidelines, one review article and one ongoing clinical trial). Scoring systems were cardiovascular risk estimation systems focusing on the primary prevention of CAD; MACE was discussed but not scored. There were 13 robust results published from completed multinational clinical trials with participants. These results focused on a scoring system for the secondary prevention of CAD and MACE. Conclusion Scoring systems remain an objective method for primary and secondary prevention of CAD and MACE. Contribution Scoring systems may be helpful with clinical uncertainty or to standardise patient results for comparison in research.

Background: Basic two-dimensional echocardiography (2D-echocardiography) screens for suspected coronary artery disease (CAD) by detecting impaired left ventricular function (LVF) which declines as atherosclerosis worsens. Aim: To evaluate basic 2D-echocardiography for CAD screening.Methods: CAD screening was performed with 2D-echocardiography. For global screening, left ventricular ejection fraction percentage (LVEF%) was determined and categorised into global systolic LVF. For regional screening, global average echocardiography score (GAES) was quantified, then categorised into functional impairment. After screening, high-risk patients underwent diagnostic coronary angiography. Abnormal angiography had >50% luminal stenosis. Angiography was also quantified with Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, then categorised. Statistical Package for Social Science 25.0 analysed data.Results: There were 471 patients screened for CAD; 154/471 (33%) underwent angiography. For angiography selection amongst 471 screened patients, GAES was higher (p<0.001) and positively correlated (Pearson’s coefficient 0.296); LVEF% was lower (p=0.002) and negatively correlated (Pearson’s coefficient -0.187). Amongst 154 patients, SYNTAX score correlated negatively with LVEF% (Pearson’s coefficient -0.276) and positively with GAES (Pearson’s co-efficient 0.180). For categories, angiography had 66/154 (42.9%) normal and 88/154 (57.1%) abnormal results. SYNTAX score had 134/154 (87.0%) low-risk and 20/154 (13.0%) medium-high-risk categories. GAES correlated positively with angiogram results (Spearman’s coefficient 0.298) and SYNTAX categories (Spearman’s coefficient 0.110). LVEF% correlated negatively with angiogram results (Spearman’s coefficient -0.307) and SYNTAX categories (Spearman’s coefficient -0.254).Conclusions: The distribution of underlying atherosclerotic vessels resulted in regional wall abnormalities being more significant than global function on 2D-echocardiography. We conclude that basic 2D-echocardiography remains useful in CAD screening.

We studied patients who did not have typical angina but CAD was suspected in them based on demographic information, medical comorbid risks, electrocardiographic (ECG) findings.