28. Validity of three risk stratification systems in a Saudi population

Abstract

Coronary artery disease (CAD) is the leading cause of death worldwide. Although there are a number of algorithms in use for determining risk and thus predicting future cardiovascular events, the data available regarding their validity among the Saudi population are insufficient. We studied the validity of three clinical score systems that are used to define high-risk patient groups: the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation, the Framingham risk score (FRS), and the European Systematic Coronary Risk Evaluation (SCORE).The new ACC/AHA Pooled Cohort Risk Equation can define high risk group among Saudi population better than the older risk stratification systems.We analyzed data from 462 patients aged ⩾40 years with no previous history of CAD. High-risk features were a coronary calcium score (CCS) of ⩾400 or, if the CCS was in the ⩾75 percentile using Multi-Ethnic Study of Atherosclerosis (MESA) score. The scores for the three algorithms were then calculated using the participants’ clinical data and lipid profiles, which had been obtained before performing computed tomography.In all, 87 (18.8%) patients were positive for coronary calcification. Among them, 60 (13%) were classified as being at high risk according to the MESA score. Analyzing these patients by The ACC/AHA Pooled Cohort Risk Equation resulted in 9 (15%) as being at low risk, 12 (20%) at intermediate risk, and 39 (65%) at high risk. The FRM risk classification resulted in 14 (23%) being at low risk, 13 (22%) at intermediate risk, and 33 (55 %) at high risk. The SCORE risk classification showed 24 (40%) at low risk, 12 (20%) at intermediate risk, and 24 (40%) at high risk, with P<0.0001.shown in the figure below.The ACC/AHA Pooled Cohort Risk Equation defined the higher risk group of patients in the Saudi population significantly better than the other two risk-score algorithms.