RT Journal Article
SR Electronic
T1 Coronary risk stratification of patients with newly diagnosed heart failure
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001074
DO 10.1136/openhrt-2019-001074
VO 6
IS 2
A1 Rasmus Bo Hasselbalch
A1 Mia Pries-Heje
A1 Thomas Engstrøm
A1 Andreas Sandø
A1 Merete Heitmann
A1 Frants Pedersen
A1 Morten Schou
A1 Hans Mickley
A1 Hanne Elming
A1 Rolf Steffensen
A1 Lars Koeber
A1 Kasper Karmark Iversen
YR 2019
UL http://openheart.bmj.com/content/6/2/e001074.abstract
AB Objective Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.Methods Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.Results The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation.Conclusions A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.