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Predictive model for left main coronary artery or triple vessel disease in patients with chronic coronary syndromes
Piyanop Nuchanat1, Komsing Methavigul1
1Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi 11000, Thailand.
Insights
A new prediction score identifies patients with chronic coronary syndromes at high risk for left main coronary artery disease/three-vessel disease. Key predictors include heart failure symptoms, suspected coronary artery disease, and specific ECG findings.
Area of Science:
- Cardiology
- Medical Diagnostics
- Predictive Modeling
Background:
- Limited data exists for predicting left main coronary artery disease (LMCAD)/three-vessel disease (TVD) in chronic coronary syndromes (CCS) patients.
- Accurate risk stratification is crucial for guiding invasive coronary angiography (ICA).
Purpose of the Study:
- To develop and validate a predictive model for LMCAD/TVD in patients with CCS.
- To identify key clinical and electrocardiographic predictors of significant coronary artery disease.
Main Methods:
- Retrospective analysis of 162 CCS patients undergoing ICA (January 2018 - December 2020).
- Logistic regression was used to identify predictors and develop a prediction score.
- Receiver operating characteristic (ROC) curve analysis determined the optimal cut-off value and assessed diagnostic performance (sensitivity, specificity, PPV, NPV, AUC).
Main Results:
- New onset heart failure (HF)/left ventricular systolic dysfunction (LVSD), suspected coronary artery disease (CAD), ST elevation (STE) in aVR, STE in V1, and lateral ST depression (STD) were significant predictors.
- The developed prediction score demonstrated an Area Under the Curve (AUC) of 0.855.
- The optimal cut-off value of 3.0 yielded sensitivity of 71.26%, specificity of 86.67%, PPV of 86.11%, and NPV of 72.22%.
Conclusions:
- New onset HF/LVSD, suspected CAD, STE in aVR, STE in V1, and lateral STD are associated with increased risk of LMCAD/TVD.
- The novel prediction score effectively identifies CCS patients at risk for LMCAD/TVD with acceptable diagnostic accuracy.
Background:
Data about prediction of left main coronary artery disease (LMCAD)/three-vessel disease (TVD) in patients with chronic coronary syndromes (CCS) are lacking.
Objectives:
This study aimed to develop a model for predicting patients at risk of LMCAD/TVD.
Methods:
This study used retrospective data from patients with CCS scheduled for invasive coronary angiography (ICA) and who were retrospectively recruited between January 2018 and December 2020. Predictors were obtained and analyzed by using logistic regression analysis, and generated the prediction score. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The cut-off value and area under the curve (AUC) were analyzed by using the receiver operating characteristic (ROC) curve.
Results:
We recruited 162 patients with CCS. There were 75 patients in the non-LMCAD/TVD and 87 patients in the LMCAD/TVD groups. After the multivariate analysis, new onset of heart failure (HF) or left ventricular systolic dysfunction (LVSD) and suspected CAD, ST elevation (STE) in aVR, STE in V1 and lateral ST depression (STD) were associated with increased risk of LMCAD/TVD. Based on these 4 predictors, the prediction score was created. The cut-off value of the prediction score by using ROC curve analysis was 3.0. The sensitivity, specificity, PPV, and NPV were 71.26%, 86.67%, 86.11%, and 72.22%, respectively, with an AUC of 0.855.
Conclusions:
The CCS patients with new onset of HF or LVSD and suspected CAD, STE in aVR, and STE in V1 and lateral STD were associated with increased risk of LMCAD/TVD. The novel prediction score could predict LMCAD/TVD in those patients with acceptable sensitivity, specificity, PPV, and NPV.
