Русский
Value of cardiovascular risk factors in pre-test assessment of coronary heart disease
DOI: https://dx.doi.org/10.18565/therapy.2023.1.70-77
Roytberg G.E., Slastnikova I.D., Sharkhun O.O., Davydova A.S.
N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
The aim of the study was to analyze the RFs for CVD in patients with various PTPs for CHD.
Material and methods. The study included 141 patients (81 males and 60 females) aged 40–75 years old (medium age 62,6±8,3 years) with suspected CHD. All participants underwent PTP calculation, standard physical examination and laboratory examination, and the presence of CVD RFs was analyzed. According to PTP results, 2 groups were formed: with low (<15%) and intermediate (≥15%) PTP. MSCT coronary angiography was performed to assess the lesion of the CA, the calcium index (CI) was calculated using the Agatston scale.
Results. Among patients with low PTP (n=84), the presence of 0–1 RF was observed in 36,9% of patients with non-obstructive coronary stenosis (1st subgroup) and only in 5,3% of patients with stenosis ≥50% (2nd subgroup). In the 2nd subgroup, the presence of 3–4 risk factors was found in 52,6% of patients, while in the 1st subgroup it was only in 21,5% (p=0,01). In this group, CI <100 was found in 84,6% of patients of the 1st subgroup, the opposite picture was obtained among patients of the 2nd subgroup: CI >100 was detected in 89,5% of patients. In the 2nd group with intermediate PTT (n=57), there was a predominance of 3–4 RFs in patients with CA stenosis ≥50% compared with persons without significant stenosis (45,8% and 18,2%, respectively, p=0,03). Extremely high CI (≥400) was observed in 58,3% of patients with obstructive stenosis, while 72,8% of patients with stenosis <50% did not have significant coronary calcification (including 36,4% of people had CI=0).
Conclusion. Patients with low PTP of CHD and one RF, as a rule, do not have obstructive CA stenosis, and in the presence of 3–4 RF, significant coronary stenosis are much more common. CI ≥100 may serve as an indication for further examination of the patient with a low probability of CHD, and CI <100 is associated with the absence of obstructive coronary stenosis in both low and intermediate PTP of CHD.
Literature
1. Барбараш О.Л., Карпов Ю.А., Кашталап В.В. с соавт. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(11): 201–250. [Barbarash O.L., Karpov Yu.A., Kashtalap V.V. et al. 2020 Clinical practice guidelines for stable coronary artery disease. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(11): 201–250 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2020-4076. EDN: THCMQS. 2. Diamond G.A., Forrester J.S. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979; 300(24): 1350–58. https://dx.doi.org/10.1056/NEJM197906143002402. 3. Foldyna B., Udelson J.E., Karady J. et al. Pretest probability for patients with suspected obstructive coronary artery disease: Re-evaluating Diamond–Forrester for the contemporary era and clinical implications: Insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019; 20(5): 574–81. https://dx.doi.org/10.1093/ehjci/jey182. 4. Juarez-Orozco L.E., Saraste A., Capodanno D. et al. Impact of a decreasing pre-test probability on the performance of diagnostic tests for coronary artery disease. Eur Heart J Cardiovasc Imaging. 2019; 20(11): 1198–207. https://dx.doi.org/10.1093/ehjci/jez054. 5. Knuuti J., Wijns W., Saraste A. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–77. https://dx.doi.org/10.1093/eurheartj/ehz425. 6. Genders T.S., Steyerberg E.W., Alkadhi H. et al.; CAD Consortium. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J. 2011; 32(11): 1316–30. https://dx.doi.org/10.1093/eurheartj/ehr014. 7. Lee U.W., Ahn S., Shin Y.S. et al. Comparison of the CAD consortium and updated Diamond–Forrester scores for predicting obstructive coronary artery disease. Am J Emerg Med. 2021; 43: 200–4. https://dx.doi.org/10.1016/j.ajem.2020.02.056. 8. Winther S., Schmidt S.E., Mayrhofer T. et al. Incorporating coronary calcification into pre-test assessment of the likelihood of coronary artery disease. J Am Coll Cardiol. 2020; 76(21): 2421–32. https://dx.doi.org/10.1016/j.jacc.2020.09.585. 9. Fyyaz S., Rasoul H., Miles C. et al. ESC 2019 guidelines on chronic coronary syndromes: could calcium scoring improve detection of coronary artery disease in patients with low risk score. Findings from a retrospective cohort of patients in a district general hospital. JRSM Cardiovasc Dis. 2021; 10: 20480040211032789. https://dx.doi.org/10.1177/20480040211032789. 10. Nicoll R., Wiklund U., Zhao Y. et al. The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients: Euro-CCAD study. Int J Cardiol. 2016; 207: 13–19.https://dx.doi.org/10.1016/j.ijcard.2016.01.056. 11. Baskaran L., Neo Y.P., Lee J.K. et al. Evaluating the coronary artery disease consortium model and the coronary artery calcium score in predicting obstructive coronary artery disease in a symptomatic mixed Asian cohort. J Am Heart Assoc. 2022; 11(8): e022697. https://dx.doi.org/10.1161/JAHA.121.022697. 12. Kolossvary M., Mayrhofer T., Ferencik M.et al. Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial. J Cardiovasc Comput Tomogr. 2022; 16(5): 397–403.https://dx.doi.org/10.1016/j.jcct.2022.03.006. 13. Al’Aref S.J., Maliakal G., Singh G. et al. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. Eur Heart J. 2020; 41(3): 359–67. https://dx.doi.org/10.1093/eurheartj/ehz565.
About the Autors
Grigory E. Roytberg, MD, professor, academician of RAS, head of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 125047, Moscow, 10 2nd Tverskoy-Yamskoy Lane. E-mail: contact@medicina.ru. ORCID: https://orcid.org/0000-0003-0514-9114
Irina D. Slastnikova, PhD in Medicinal Sciences, associate professor of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 125047, Moscow, 10 2nd Tverskoy-Yamskoy Lane. E-mail: slastid@mail.ru. ORCID: https://orcid.org/0000-0002-4076-2849
Olga O. Sharkhun, MD, associate professor, professor of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 125047, Moscow, 10 2nd Tverskoy-Yamskoy Lane. E-mail: olga_sharkhun@mail.ru. ORCID: https://orcid.org/0000-0001-8527-4681
Alina Sh. Davydova, postgraduate student of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 125047, Moscow, 10 2nd Tverskoy-Yamskoy Lane. E-mail: alina.tsyganova@gmail.com. ORCID: https://orcid.org/0000-0002-5738-0740
Similar Articles
