Utility of Systematic Coronary Risk Evaluation (SCORE) system to predict coronary artery disease severity in low to moderate risk hypertensive patients undergoing elective coronary angiography
Abstract
Background: Coronary artery disease (CAD) is the leading cause of mortality in hypertensive patients. Systematic Coronary Risk Evaluation (SCORE) is the preferred scoring system to predict future fatal cardiovascular events in hypertensive patients. However, the relationship between SCORE and coronary atherosclerosis is not well described. We aimed to investigate whether SCORE has a relationship with CAD severity in hypertensive patients, even in the absence of high risk features.
Material and methods: Four hundred and fifty-two hypertensive patients who underwent elective coronary angiography and defined as low or moderate risk according to SCORE were included into the study. Patients were divided into two groups. Patients with a SCORE < 1% were defined as low risk group, and patients with a SCORE ≥ 1% and < 5% were defined as moderate risk group. The groups were compared regarding CAD severity.
Results: The frequency of stenotic CAD and multivessel disease, and mean SYNTAX score, were significantly higher in SCORE ≥ 1%, and < 5% group compared to patients with SCORE < 1%. Correlation analysis revealed a significant positive moderate correlation between SCORE and SYNTAX score (Pearson’s r: 0.679, p < 0.001). ROC curve analysis demonstrated that a SCORE ≥ 3% predicted SYNTAX score > 22 with a sensitivity of 75% and a specificity of 86.5% (AUC: 0.879, p < 0.001). Furthermore, multivariate analysis demonstrated that SCORE was an independent predictor of stenotic CAD (OR: 1.616, p < 0.001), multivessel disease (OR: 1.913, p < 0.001), and SYNTAX score > 22. (OR: 1.817, p < 0.001).
Conclusion: Our results suggest that SCORE is associated with CAD severity in hypertensive patients even in the
absence of high risk features. The SCORE system may be useful in further risk stratification of hypertensive patients
with moderate risk features and suspected CAD.
Keywords: hypertensioncoronary artery diseasecoronary angiographySCORESYNTAX score
References
- Kannel W. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA. 1996; 275(20): 1571–1576.
- Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349): 1903–1913.
- Schmieder RE. End organ damage in hypertension. Dtsch Arztebl Int. 2010; 107(49): 866–873.
- Williams B, Mancia G, Spiering W, et al. Authors/Task Force Members:, ESC Scientific Document Group . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
- Conroy RM, Pyörälä K, Fitzgerald AP, et al. SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11): 987–1003.
- Piepoli MF, Hoes AW, Agewall S, et al. Authors/Task Force Members:, Authors/Task Force Members, Additional Contributor: Simone Binno (Italy), Document Reviewers:, ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
- Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1(2): 219–227.
- Neumann FJ, Sousa-Uva M, Ahlsson A, et al. ESC Scientific Document Group, ESC Scientific Document Group. Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 204–212.
- Serruys PW, Onuma Y, Garg S, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5(1): 50–56.
- McInnes GT. Hypertension and coronary artery disease: cause and effect. J Hypertens Suppl. 1995; 13(2): S49–S56.
- Escobar E. Hypertension and coronary heart disease. J Hum Hypertens. 2002; 16(S1): S61–S63.
- Weber T, Lang I, Zweiker R, et al. Hypertension and coronary artery disease: epidemiology, physiology, effects of treatment, and recommendations : A joint scientific statement from the Austrian Society of Cardiology and the Austrian Society of Hypertension. Wien Klin Wochenschr. 2016; 128(13-14): 467–479.
- Cooney MT, Dudina AL, Graham IM. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians. J Am Coll Cardiol. 2009; 54(14): 1209–1227.
- Tolunay H, Kurmus O. Comparison of coronary risk scoring systems to predict the severity of coronary artery disease using the SYNTAX score. Cardiol J. 2016; 23(1): 51–56.
- Yalcin M, Kardesoglu E, Aparci M, et al. Cardiovascular risk scores for coronary atherosclerosis. Acta Cardiol. 2012; 67(5): 557–563.
- Lee BC, Lee WJ, Hsu HC, et al. Using clinical cardiovascular risk scores to predict coronary artery plaque severity and stenosis detected by CT coronary angiography in asymptomatic Chinese subjects. Int J Cardiovasc Imaging. 2011; 27(5): 669–678.
- Koenig W, Ridker PM. Rosuvastatin for primary prevention in patients with European systematic coronary risk evaluation risk ≥ 5% or Framingham risk >20%: post hoc analyses of the JUPITER trial requested by European health authorities. Eur Heart J. 2011; 32(1): 75–83.