Comparative Study of Scores for Prediction of Coronary Artery Disease Severity: Evaluation of a Newly Formulated CHA2DS2-VASc-HSLp(a) Score OC17-OC21
Dr. Dharmendra Jain,
C-2, New Medical Enclave, Near Naria gate, BHU, Varanasi-221005, Uttar Pradesh, India.
Introduction: The Framingham Risk Score (FRS) and CHA2DS2- VASc scores include risk factors for the development of Coronary Artery Disease (CAD). On review of literature, one study concluded that CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD. CHA2DS2-VASc-HS score was made by adding hyperlipidaemia and smoking to CHA2DS2-VASc score. In developing countries like India, other than hyperlipidemia and smoking, Lipoprotein-(a) is an independent risk factor of CAD and adding Lipoprotein-(a) to CHA2DS2-VASc-HS score could be a better predictor of CAD in Indians.
Aim: To formulate a new CHA2DS2-VASc-HSLp(a)) score by including hyperlipidemia, smoking and Lipoprotein-(a) and to compare it with FRS and CHA2DS2-VASc score. Hence to better predict CAD severity especially in developing countries like India.
Materials and Methods: A total of 516 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. This study investigated whether these three scores can be used to predict CAD severity. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS version 16.0) for Windows (SPSS Inc., Chicago, Illinois).
Results: Out of 516 patients, 31 had normal coronary angiograms or mild CAD. The remaining 485 patients with coronary stenosis were further classified into single, double and triple vessel disease. The FRS, CHA2DS2-VASc, and CHA2DS2-VASc-HSLp(a) Scores correlated significantly with the number of significant diseased vessels and highest predictive ability was found with CHA2DS2- VASc-HSLp(a) score (r=0.157, r=0.279, and r=0.461, p<0.001, respectively). The diagnostic accuracy and Positive predictive value were 87.2% and 97.7% obtained for CHA2DS2-VAScHSLp(a) score with optimum Lp(a) cut-off =19 mg/dL. In addition, these three scores correlated significantly with the Gensini score and highest predictive ability was found with CHA2DS2- VASc-HSLp(a) score (r=0.194, r=0.459, and r=0.587, p<0.001 respectively).
Conclusion: FRS, CHA2DS2-VASc, and especially CHA2DS2- VASc-HSLp(a) scores could be considered predictive of the risk of severe CAD. The CHA2DS2-VASc-HSLp(a) score was found to be the better scoring scheme to predict CAD severity in Indian population.