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 CO ronary R isk S core in WO men (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. CLINICAL PERSPECTIVE What Is New? The coronary risk stratification of women depends on of the multiple clinical, exercise and imaging variables. This new risk score allows the risk to be calculated for individual women in a simple way with a mean of a 4-year follow-up. What Are the Clinical Implications? CORSWO is an effective tool to stratify the risk for major adverse coronary event in 5 risk levels, very low, low, moderate, high and very high risk with a good accuracy.