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Stratification of symptomatic patients with low to intermediate risk of coronary artery disease

Session Poster session 1

Speaker Simon Winther

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : S Winther (Aarhus,DK), L Nissen (Herning,DK), J Westra (Aarhus,DK), L Frost (Silkeborg,DK), G Urbonaviciene (Silkeborg,DK), NR Holm (Aarhus,DK), EH Christiansen (Aarhus,DK), HE Botker (Aarhus,DK), M Bottcher (Herning,DK)

Authors:
S. Winther1 , L. Nissen2 , J. Westra1 , L. Frost3 , G. Urbonaviciene3 , N.R. Holm1 , E.H. Christiansen1 , H.E. Botker1 , M. Bottcher2 , 1Aarhus University Hospital, Dept. of Cardiology - Aarhus - Denmark , 2Regional Hospital West Jutland, Dept. of Cardiology - Herning - Denmark , 3Regional Hospital Central Jutland, Dept. of Cardiology - Silkeborg - Denmark ,

On behalf: DAN-NICAD study group

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 189

Background: Clinical risk stratification of patients with symptoms suggestive of obstructive coronary artery disease (CAD) remains a challenge. The initial diagnostic test often turns out to be normal and requires substantial healthcare resources. However, current primary risk prediction model, Diamond-Forrester score (DF-score), are currently not validated in patients with low/intermediate risk.

Purpose: To investigate the ability of clinical risk factors and DF-score to predict patients with suspected hemodynamically obstructive CAD compared to coronary artery calcium score (CACS).

Methods: We included 1675 consecutive patients (male: 49% mean age 57±8 years) referred to coronary computed tomography angiography (CTA) with symptoms suggestive of CAD and a low-intermediate risk profile. A medical interview was conducted prior to coronary CTA to obtain clinical risk factors. All patients with suspected obstructive CAD by coronary CTA (>50% diameter stenosis) were subsequently investigated by invasive coronary angiography and fractional flow reserve measurements. Hemodynamically obstructive CAD was defined as FFR ≤0.80.

Results: Median DF-score was 0.39 [IQR 0.20–0.53], 83% were at intermediate risk (DF-score 0.15–0.85). A total of 391 (23%) patients had suspected obstructive CAD by coronary CTA and 161 (10%) patients had hemodynamically obstructive CAD verified by invasive coronary angiography. The relative risk ratio of CAD according to single risk factors, symptoms, medication, DF-score and CACS is illustrated in figure. The area under the receiver operating characteristic curve for DF-score was 0.68 (CI: 0.63–0.72), and CACS was 0.86 (CI: 0.83–0.89), p<0.001.

Conclusion: In a cohort of patients with low/intermediate likelihood and symptoms suggestive of CAD, CACS is a very strong predictor of hemodynamically obstructive CAD. Single clinical risk factors and DF-score only show limited capacity for risk stratification.

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