Validation of a Novel Clinical Prediction Score for Severe Coronary Artery Diseases before Elective Coronary Angiography

Abstract

ObjectivesCoronary artery disease (CAD) severity is associated with patient prognosis. However, few efficient scoring systems have been developed to screen severe CAD in patients with stable angina and suspected CAD before coronary angiography. Here, we present a novel scoring system for CAD severity before elective coronary angiography.MethodsFive hundred fifty-one patients with stable angina who were admitted for coronary angiography were enrolled in this study. Patients were divided into training (n = 347) and validation (n = 204) cohorts. Severe CAD was defined as having a Gensini score of 20 or more. All patients underwent echocardiography (ECG) to detect ejection fraction and aortic valve calcification (AVC). Multivariable analysis was applied to determine independent risk factors and develop the scoring system.ResultsIn the training cohort, age, male sex, AVC, abnormal ECG, diabetes, hyperlipidemia, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were identified as independent factors for severe CAD by multivariable analysis, and the Severe Prediction Scoring (SPS) system was developed. C-indices of receiver operating characteristic (ROC) curves for severe CAD were 0.744 and 0.710 in the training and validation groups, respectively. The SPS system also performed well during calibration, as demonstrated by Hosmer-Lemeshow analysis in the validation group. Compared with the Diamond-Forrester score, the SPS system performed better for severe CAD prediction before elective coronary angiography.ConclusionsSevere CAD prediction was achieved by analyzing age, sex, AVC, ECG, diabetes status, and lipid levels. Angina patients who achieve high scores using this predicting system should undergo early coronary angiography.

Prevalence of type 2 diabetes mellitus and association of HbA1c with severity of coronary artery disease in patients presenting as non-diabetic acute coronary syndrome

“…Gensini score estimates the severity of atherosclerosis in coronary vessels very well and calculates the disease burden depending upon the severity of vessel stenosis, its location, and the area at risk with the lesion [6,8]. Patients with Gensini scores of 20 or more are defined as having severe CAD, which was approximately equal to one stenosed lesion of 70% or more in the proximal left anterior descending artery [32]. The mean Gensini score in our study was 22.51 ± 10.37.…”

Derivation and Validation of Prognosis-Based Age Cutoffs to Define Elderly in Cardiac Surgery

“…The first is that older patients have more severe and diffuse cardiovascular disease. 13 Our selected group of patients is notable in that all had de facto severe coronary or valvular heart disease that required surgical intervention, making this less relevant to explain the findings in our specific cohort. The second reason is that older patients are less likely to receive adjunctive medical therapies.…”

Association of a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 polymorphisms with severity of coronary stenosis in type 2 diabetes mellitus

“…[ 17 ] Patients with Gensini score ≥20 were classified as high score, while those presenting the score < 20 were defined as low–medium score. [ 18 ] Other clinical variables including age, sex, CAD risk factors, and use of medicines were obtained from medical records. Individuals presenting one or more of the following parameters: total cholesterol (TC) ≥6.2 mmol/L, triglyceride ≥2.3 mmol/L, high-density lipoprotein-cholesterol (HDL-C) <1.0 mmol/L, and low-density lipoprotein-cholesterol (LDL-C) ≥4.1 mmol/L or use of lipid-lowering drugs were diagnosed as dyslipidemia.…”