Abstract
Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer–Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient–physician shared decision-making.
Highlights
40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndromeX (CSX)
The third one was the SCORE project introduced by European Society of Cardiology to estimate 10-year risk of cardiovascular mortality (SCORE) [26]. These risk scores help to assess different clinical outcomes, we aimed to examine their efficiency in the prediction of CAG findings
We believe that algorithms that are more detailed will be required to establish the method of choice from noninvasive imaging and CAG for a state-of-the-art practice in each clinical situation
Summary
40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndromeX (CSX). 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome. Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). Several studies have shown that 10% to 30% of patients undergoing CAG have normal or near normal coronary arteries [1]. In a large cohort study of patients suspected to have myocardial ischemia, 41% of women versus only 8% of men had normal or near-normal coronary arteries in CAG [15]. Several studies have proposed risk prediction models for obstructive CAD in CAG [19,20,21,22,23]
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