New coronary risk score enhances prediction of heart events in women
A recent study introduces the COronary Risk Score in WOmen, improving the prediction of major adverse coronary events in women and addressing gender gaps in cardiovascular research.
New coronary risk score enhances prediction of heart events in women | Image Credit: © SewcreamStudio - © SewcreamStudio - stock.adobe.com.
Adverse cardiovascular events such as heart attacks may be predicted in women using a new coronary risk score, according to a recent study published in Radiology: Cardiothoracic Imaging.1
Heart disease has been reported by the Centers for Disease Control and prevention as the leading cause of death in women. However, conditions such as coronary artery disease more often present in men, leading to women often being underrepresented in cardiovascular studies.
“Women are often underrepresented in research studies, and in some settings may be excluded,” said lead study author Guillermo Romero-Farina, MD, PhD. “Risk stratification in women is particularly important because the clinical presentation of coronary disease in women may differ from that in men and is often atypical.”
Investigators conducted the observational cohort study to establish a COronary Risk Score in WOmen (CORSWO) for the prediction of major adverse coronary events (MACE).2 Women aged 40 to 93 years receiving gated SPECT myocardial perfusion imaging (gSPECT MPI) from 2000 to 2018 were included, with those only receiving stress testing excluded.
Stress-rest gSPECT MPI was conducted in all 2226 participants, subjective maximal exercise MPI in 1410, submaximal exercise plus pharmacologic test in 80, and only pharmacologic MPI in 409. Each segment was assigned a score of 0 to 4, with 0 meaning normal perfusion, 1 mild perfusion, 2 moderate perfusion, 3 severe perfusion, and 4 no uptake.
Follow-up occurred in the hospital for a minimal 1 year and a maximum 10 years, with a mean follow-up period of 4 years. During this period, MACE data was collected, including unstable angina, nonfatal myocardial infarction (MI), coronary revascularization, and cardiac death.
Participants were aged a mean 66.7 years, with overall mortality and MACE rates of 6.7% and 6.6%, respectively. Additional rates included 2.6% for unstable angina, 1.7% for nonfatal MI, 2.9% for coronary revascularization, and 4.3% for cardiac death.
Coronary revascularization was performed in 64 patients. Of these, 33 received early coronary revascularization and 31 received late coronary revascularization.
Patients were divided into a training group and validation group, containing 65.6% and 34% of patients, respectively. Variables in the training group were selected when the P value was 0.5 or less. For each variable obtained in the training group, the probability of MACE was assessed in the validation group.
The training group presented with an overall mortality rate of 10.3% and a MACE rate of 10.1% MACE prediction was performed using 4 multivariable models. Independent predictors of MACE in the first model included diabetes with a hazard ratio (HR) of 1.95, nitrate use with an HR of 1.72, age over 69 years with an HR of 1.71, and prior MI with an HR of 1.62.
This first model used clinical variables, while the second model used stress test variables. Predictors of MACE in the second model included pharmacologic test and ST depression of 1 mm or higher, with HRs of 2.41 and 2.34, respectively.
The third model used gSPECT MPI variables. Those identified as independent predictive variables included summed rest score over 9.6%, summed stress score over 6.6%, summed difference score over 5.2%, end-diastolic volume index over 38 mL, and end-systolic volume index over 15 mL, with HRs of 2.14, 1.96, 2.65, 0.52, and 3.3, respectively.
Finally, the fourth predicted model used all independent predictive variables selected in prior models. The validation group reported an overall mortality rate of 8.9% and a MACE rate of 9.4%.
When applying z-scores from the training group to the validation group, higher CORSWO levels were linked to higher MACE prevalence. The final model had an area under the receiver operating characteristic curve of 0.78 for high-risk and very high-risk individuals.
These results highlighted efficacy of the CORSWO toward measuring MACE risk in female patients. Investigators plan to conduct additional research about how risk stratification may be influenced by left ventricular synchrony, remodeling, coronary CT, and myocardial flow.
References
- Researchers develop new coronary risk score for women. Radiological Society of North America. December 5, 2024. Accessed December 19, 2024. https://www.eurekalert.org/news-releases/1067031
- Romero-Farina G, Aguadé-Bruix S, Ferreira-González I. Prediction of major adverse coronary events using the coronary risk score in women. Radiology: Cardiothoracic Imaging. 2024;6(6). doi:10.1148/ryct.230381
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