Prediction of Major Adverse Coronary Events Using the Coronary Risk Score in Women

Purpose To establish a COronary Risk Score in WOmen (CORSWO) to predict major adverse coronary events (MACE). Materials and Methods This retrospective analysis included 2226 female individuals (mean age, 66.7 years ± 11.6 [SD]) from a cohort of 25 943 consecutive patients referred for clinical gated SPECT myocardial perfusion imaging (gSPECT MPI). During the follow-up (mean, 4 years ± 2.7) after gSPECT MPI, occurrence of MACE (unstable angina requiring hospitalization, nonfatal 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, multiple Cox regression analyses were performed. Results In the training group, 148 female individuals had MACE (2.6% per year). The best model (area under the receiver operating characteristic curve [AUC]: 0.80 [95% CI: 0.74, 0.83]; Brier score: 0.08) to predict MACE in female individuals included the following variables: age older than 69 years (hazard ratio [HR]: 1.58, P = .01), diabetes mellitus (HR: 1.47, P = .03), pharmacologic test (HR: 1.63, P = .01), ST-segment depression (≥1 mm) (HR: 2.02, P < .001), myocardial ischemia greater than 5% (HR: 2.21, P < .001), perfusion defect at rest greater than 9% (HR: 1.96, P = .009), perfusion defect at stress greater than 6% (HR: 1.63, P = .03), and end-systolic volume index greater than 15 mL (HR: 2.04, P < .001). During validation, the model achieved moderate performance (AUC: 0.78 [95% CI: 0.70, 0.83]). CORSWO obtained from these variables allowed for stratification of female individuals into four risk levels: low (score: 0-3, HR: 1), moderate (score: 4-6, HR: 1.58), high (score: 7-11, HR: 4.13), and very high (score: >11, HR: 13.87). The high and very high risk levels (HR: 5.29) predicted MACE in female individuals, with excellent performance (AUC: 0.78 [95% CI: 0.72, 0.80]). Conclusion With clinical, stress test, and gSPECT MPI variables, CORSWO effectively stratified female individuals according to coronary risk and was able to detect those with high and very high risk. Keywords: SPECT, Cardiac, Coronary Arteries, Women, Risk Stratification, Cardiac Event, CORSWO, MACE, Gated SPECT Supplemental material is available for this article. ©RSNA, 2024.