Predicting the Likelihood for Severe CAD and CABG Indication on Elective Patients: Comparison of Novel CHA2DS2-VASc-HSF with CHA2DS2 and CHA2DS2-VASc Score

Abstract

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.

Comparison of Novel Risk Score CHA2DS2-VASc-HSF to CHADS2and CHA2DS2-VASc Scores to Predict the Risk of Severe Coronary Artery Disease

“…In group B, the CHADS2 score was significantly higher compared to groups A and C, while there was no significant difference between groups B and C. Both the CHA2DS2-VASc and CHA2DS2-VASc-HSF scores were significantly higher in group B compared to groups A and C, and the scores were also significantly higher in group A compared to group C. Similarly significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF scores in patients with severe CAD compared to those with normal angiography was reported [5] .…”

“…Conversely, in another study [5] there were no significant differences in blood pressure (both SBP and DBP) across the three groups.…”

“…In the current study, groups A and B had significantly higher average ages compared to group C, but there was no significant age difference between groups A and B. Group B had significantly more males compared to groups A and C, while there was no significant difference in sex between groups A and C. BMI was significantly higher in group B compared to groups A and C, and it was also significantly higher in group A compared to group C. Also, a study was conducted [5] on 210 patients who underwent coronary angiography, categorizing them into three groups: normal angiogram, mild CAD, and severe CAD. They found that age was a differentiating factor, with those in the severe CAD group being older.…”

“…The CHA2DS2-VASc-HSF score showed a higher area under the curve (AUC) compared to the CHADS2 and CHA2DS2-VASc scores, suggesting its superior predictive value for severe CAD [5] .…”

“…This suggests CHA2DS2-VASc score may predict the risk for both cerebrovascular and cardiovascular diseases. However, these scores did not include the major risk factors of CAD such as smoking, hyperlipidemia, and family histories [5] .…”