Prediction of a major adverse coronary event in Women through CORSWO

Abstract

BACKGROUND. In women, risk stratification for a major adverse coronary event (MACE) is complex, and moreover women have often been underrepresented in cardiovascular studies. This study aims to establish a COronary Risk Score in WOmen (CORSWO) to predict MACE. METHODS. From a cohort of 25,943 consecutive patients referred for clinical gSPECT-MPI (gated single-photon emission computed tomography myocardial perfusion imaging), 2,226 women (aged 66.7±11.6 years) were included. During the follow-up (mean 4±2.7 years) post gSPECT-MPI, MACE (unstable-angina requiring hospitalization, non-fetal myocardial infarction, coronary revascularization, cardiac death) was assessed. The patients were divided into training (n=1460) and validation (n=766) groups. To obtain the predictor model, LASSO-regression analysis with 10-fold cross-validation was used. RESULTS. In training group, 148 women had MACE (0.026/patient/year). The best model (ROC area:0.8, Brier score:0.0777) to stratify women included: age >69 years (OR:1.6); diabetes mellitus (OR:2); angina-history (OR:1.6); nitrate (OR:1.5); left bundle branch block (OR:1.2); pharmacological test (OR:1.6); ST-segment-depression (≥1mm) (OR:2); stress angina (OR:1.3); myocardial ischemia >5% (OR:2.6); perfusion defect at rest >9% (OR:2.4); perfusion defect at stress >6% (OR:1.7); end-systolic volume index >15 ml (OR:1.6); and left ventricular ejection fraction <50% (OR:1.2). This model was validated (validation group) with a strong prediction (ROC area:0.8, Brier score:0.0747). The CORSWO obtained from these variables allows the stratification of women into five risk levels: very low (score:0,HR:1), low (score:1-2,HR:1.5), moderate (score:3-6,HR:2.7), high (score:7-10,HR:6.9) and very high (score:≥11,HR:21.7). CONCLUSIONS. In a clinical practice setting we can obtain an excellent coronary risk stratification in women, however at the expense of multiple variables.