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

Area of Science:

• Cardiology
• Nuclear Cardiology
• Medical Imaging

Background:

• Predicting major adverse coronary events (MACE) in women is crucial for cardiovascular health.
• Existing risk scores may not adequately address the specific risk factors and presentation of MACE in female populations.
• Gated SPECT myocardial perfusion imaging (gSPECT MPI) provides valuable functional and anatomical information for cardiac risk assessment.

Purpose of the Study:

• To develop and validate the COronary Risk Score in WOmen (CORSWO) for predicting MACE in female patients.
• To identify key clinical, stress test, and gSPECT MPI variables predictive of MACE in women.
• To stratify women into distinct risk categories for MACE based on the CORSWO.

Main Methods:

• Retrospective analysis of 2226 female patients from a larger cohort undergoing clinical gSPECT MPI.
• Development of a multivariable Cox regression model using training (n=1460) and validation (n=766) groups.
• Assessment of MACE occurrence (unstable angina, myocardial infarction, revascularization, cardiac death) during a mean 4-year follow-up.

Main Results:

• The CORSWO model, incorporating age >69, diabetes, pharmacologic test, ST depression, myocardial ischemia >5%, rest perfusion defect >9%, stress perfusion defect >6%, and end-systolic volume index >15 mL, demonstrated good predictive performance (AUC 0.80 in training, 0.78 in validation).
• CORSWO effectively stratified women into low, moderate, high, and very high MACE risk levels (HRs 1, 1.58, 4.13, 13.87, respectively).
• High and very high risk strata (combined HR 5.29) showed excellent performance in predicting MACE (AUC 0.78).

Conclusions:

• The CORSWO is a validated tool that effectively stratifies women by coronary risk using readily available clinical and gSPECT MPI data.
• The score accurately identifies women at high and very high risk of MACE, enabling targeted preventive strategies.
• CORSWO enhances risk assessment in women, complementing existing cardiovascular risk prediction models.