Novel CHA2DS2-VASc-HSF is Superior to CHADS2 and CHA2DS2-VASc Score to Predict the Risk of Severe Coronary Artery Disease

Andrianto Andrianto; Benny  Jovie; Makhyan Jibril Al Farabi; Parama Gandi; Khubay Alvia Shonafi; Rofida Lathifah

doi:10.3889/oamjms.2020.3393

Authors

Andrianto Andrianto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo Academic General Hospital, Surabaya, Indonesia
Benny Jovie Department of Cardiology and Vascular Medicine, Dr Ramelan Navy Hospital, Surabaya, Indonesia
Makhyan Jibril Al Farabi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo Academic General Hospital, Surabaya, Indonesia; School of Healthcare Management, University College London, Gower St, Bloomsbury, London, United Kingdom
Parama Gandi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo Academic General Hospital, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr Ramelan Navy Hospital, Surabaya, Indonesia
Khubay Alvia Shonafi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo Academic General Hospital, Surabaya, Indonesia
Rofida Lathifah Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3393

Keywords:

Atherosclerosis, Coronary Occlusion, Gensini Score, Risk Prediction

Abstract

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score.

AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score.

MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1.

RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD.

CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics-2008 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2008;117(4):e25- 146. https://doi.org/10.1161/circulationaha.107.187998 PMid:18086926

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: A report from the American heart association. Circulation. 2018;137(12):e67-492. https://doi. org/10.1161/cir.0000000000000573 PMid:29386200

Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease. Lancet. 1999;353(9147):89- 92. https://doi.org/10.1016/s0140-6736(98)10279-9 PMid:10023892

Ministry of Health Indonesia. Sample Registration System 2014. Indonesia: NIHRD Library Cataloguing in Publication Data; 2015. Available from: https://www.litbang.kemkes.go.id/ wp-content/uploads/2017/10/final-report-srs-2014.pdf. [Last accessed on 2019 Mar20].

Kočka V. The coronary angiography-an old-timer in great shape. Cor et Vasa. 2015;57(6):e419-24. https://doi.org/10.1016/j. crvasa.2015.09.007

Modesti PA, Agostoni P, Agyemang C, Basu S, Benetos A, Cappuccio FP, et al. Cardiovascular risk assessment in low-resource settings: A consensus document of the European society of hypertension working group on hypertension and cardiovascular risk in low resource settings. J Hypertens. 2014;32(5):951-60. https://doi.org/10.1097/hjh.0000000000000125 PMid:24577410

January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr., et al. 2019 focused update on atrial fibrillation AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fbrillation: A report of the American college of cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol 2019;140:e125-e51. https://doi.org/10.1161/cir.0000000000000665

Henriksson KM, Farahmand B, Johansson S, Asberg S, Terént A, Edvardsson N. Survival after stroke-the impact of CHADS2 score and atrial fibrillation. Int J Cardiol. 2010;141(1):18-23. https://doi.org/10.1016/j.ijcard.2008.11.122 PMid:19144430

Loh E, Sutton MS, Wun CC, Rouleau JL, Flaker GC, Gottlieb SS, et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med. 1997;336(4):251-7. https://doi.org/10.1056/nejm199701233360403 PMid:8995087

Yarmohammadi H, Varr BC, Puwanant S, Lieber E, Williams SJ, Klostermann T, et al. Role of CHADS2 score in evaluation of thromboembolic risk and mortality in patients with atrial fibrillation undergoing direct current cardioversion (from the ACUTE trial substudy). Am J Cardiol. 2012;110(2):222-26. https://doi.org/10.1016/j.amjcard.2012.03.017 PMid:22503581

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: A report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European Society of cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. https://doi.org/10.1016/j. echo.2005.10.005 PMid:16376782

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. https://doi.org/10.1093/clinchem/18.6.499 PMid:4337382

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics. 1988;44(3):837-45. https://doi.org/10.2307/2531595 PMid:3203132

Zhao Y, Shaista M, Nathan D. Evidence for coronary artery calcification screening in the early detection of coronary artery disease and implications of screening in developing countries. Glob Heart. 2014;9(4):399-407. https://doi.org/10.1016/j. gheart.2014.10.005 PMid:25592793

Cetin M, Cakici M, Zencir C, Tasolar H, Baysal E, Balli M, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2- VASc-HS score. Am J Cardiol. 2014;113(6):950-6. https://doi. org/10.1016/j.amjcard.2013.11.056 PMid:24444782

Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1):293-8. PMid:1985385

Menotti A, Puddu PE, Lanti M. Comparison of the framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000;21(5):365-70. https:// doi.org/10.1053/euhj.1999.1864 PMid:10666350

Onat A, Can G, Hergenç G, Küçükdurmaz Z, Ugur M, Yüksel H. High absolute coronary disease risk among Turks: Involvement of risk factors additional to conventional ones. Cardiology. 2010;115(4):297-306. https://doi.org/10.1159/000312009 PMid:20395681

Siontis GC, Tzoulaki I, Siontis KC, Ioannidis JP. Comparisons of established risk prediction models for cardiovascular disease: Systematic review. BMJ. 2012;344:e3318. https://doi. org/10.1136/bmj.e3318 PMid:22628003

D’Agostino RB Sr., Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The framingham heart study. Circulation. 2008;117(6):743-53. https://doi.org/10.1161/ circulationaha.107.699579 PMid:18212285

Naik G, Sekhar S, Prabhu M, Singh G, Vijay A, Subrahmanian M, et al. Comparison of CHA2DS2-VASc-HS score and gensini score to predict severity of coronary artery disease. J Clin Diagn Res. 2018;12(7):IC01-4. https://doi.org/10.7860/ jcdr/2018/28509.11802

Al-shorbagy AN, Al-Cekelly MM, Dwedar AA, Soliman MM. The predictive value of newly defined CHA2DS2-VASC-HSF score for severity of coronary artery disease in non ST segment elevation myocardial infarction. Zagazig Univ Med J. 2018;24(4):289-96. https://doi.org/10.21608/zumj.2018.13209

Poci D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K. Role of the CHADS2 score in acute coronary syndromes: Risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest. 2012;141(6):1431-40. https://doi.org/10.1378/chest.11-0435 PMid:22016485

Kim KH, Kim W, Hwang SH, Kang WY, Cho SC, Kim W, et al. The CHA2DS2VASc score can be used to stratify the prognosis of acute myocardial infarction patients irrespective of presence of atrial fibrillation. J Cardiol. 2015;65(2):121-7. https://doi. org/10.1016/j.jjcc.2014.04.011 PMid:24972564

Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, et al. CHA2DS2-VASc score predicts in-hospital and long-term clinical outcomes in patients with st-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention. Clin Appl Thromb Hemost. 2017;23(2):132-8. https://doi.org/10.1177/1076029616646874 PMid:27170782