Abstract 12152: Framingham Risk Score Predicts Probability of Significant Coronary Artery Stenosis in Stable Symptomatic Patients: Results from the Multinational CONFIRM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)
Background: Clinical utility of the Framingham Risk Score (FRS) is accepted in asymptomatic patients and questioned in symptomatic patients. In a large cohort of stable patients who underwent coronary CT angiography (CCTA), we examined whether the addition of FRS to presenting symptom improved pre-test prediction of obstructive coronary artery disease (Ob-CAD), defined as =50% diameter narrowing in a major coronary artery.
Methods: From 5 centers in 4 countries, we studied 4865 consecutive patients (58% men, median age 60, 9% diabetics) without known CAD. Symptoms were categorized using classic angina criteria into: Asymptomatic (Asym), nonanginal pain (NonAng), atypical angina (AtypAng), typical angina (TypAng), and dyspnea (Dysp). FRS was calculated to estimate 10-year cardiovascular event risk as low (<10%), intermediate (10–19%), or high (=20%). All CCTA were performed on 64-slice scanners and evaluated for presence of Ob-CAD using a modified 18-segment coronary tree model.
Results: Rates of Ob-CAD were 20% in Asym (n=325), 21% in NonAng (n=107), 21% in AtypAng (n=323), 35% in TypAng (n=223), and 27% in Dysp (n=138). FRS risk status significantly stratified the probability of finding Ob-CAD for all symptom categories, particularly when intermediate or high risk groups were compared to low (p<0.001 for all comparisons, Figure). Low risk by FRS identified low rates of Ob-CAD (<22%) in all symptom groups, including TypAng. The lowest rates of Ob-CAD were found in Asym, NonAng, and AtypAng patients at low risk by FRS (15%, 14%, and 14%). The highest rate was found in TypAng patients at high risk by FRS (62%).
Conclusion: Addition of FRS-estimated 10-year risk status to presenting symptom improved the estimation of Ob-Cab probability in stable patients undergoing CCTA, irrespective of symptom classification. However, even in the setting of typical angina with high risk by FRS, a significant proportion of patients did not exhibit Ob-CAD.
- © 2010 by American Heart Association, Inc.