To Evaluate Efficiency of Various Coronary Artery Disease Risk Scores With Traditional Risk Factors in Patients Undergoing Coronary Angiography.

Abstract

Objective: To analyze and compare various cardiovascular disease risk scores in Western Indian patients undergoing Coronary angiogram (CAG).

Methods: In this prospective cross-sectional study, 1213 patients who underwent conventional coronary angiography; clinical risk profile and biochemical investigations were evaluated prior to undergoing CAG. Apart from the demographic information, 10-year absolute risk of having a major cardiovascular event (cardiovascular death, myocardial infarction or stroke) was calculated for each patient using various available Traditional Risk Scores (TRS). The population was divided in low, intermediate and high-risk categories for each of these scores.

Results: Traditional cardiovascular risk factors like hypertension (41.8%) and diabetes mellitus-II (26.9%) were the two most prevalent risk factors in our study population. A higher risk value for all these TRS was more likely to be associated with obstructive coronary artery disease (OCAD) on CAG. Patients with high risk (≥20% for 10-year) QRESEARCH (QRISK3) score category had higher number of patients with obstructive CAD (49.6%) as compared to high risk category of risk score for those with high Global Registry of Acute Coronary Events (GRACE) score (46.6%) or risk Framingham (FRS CHD) score (29.2%) and risk atherosclerotic cardiovascular disease (ASCVD) score (30.1%) (P < 0.0001). A higher TRS was more likely to be associated with obstructive CAD, with the highest predictability being with QRISK3 (QRISK3 score 60.9%, GRACE score 54.9%, FRS-CHD score 34% and ASCVD score 42.1% respectively; P < 0.0001). A substantial study population (27.4%) cannot be identified using any of these TRS and hence a need of indigenous or modified risk scores is proposed.

Conclusion: QRISK3 score was most efficacious for predicting obstructive CAD in our Indian study population on CAG. A higher risk score also correlated with the number of vessels involved on coronary angiogram. A substantial obstructive CAD patient could not be identified using traditional risk scores hence need for an indigenous or modified score.