Novel CHA2DS2-VASc-HSF is Superior to CHADS2 and CHA2DS2-VASc Score to Predict the Risk of Severe Coronary Artery Disease

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score. AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score. MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1. RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD. CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist

Coronary Artery Disease in the Military Setting: Lower Gensini Score in High-Rank Personnel Compared to Low-Rank and Civilian

Background: Studies had reported an increasing trend of coronary artery disease (CAD) cases in the military population. However, the severity of the CAD among different military rank is yet to be studied. The Gensini scoring system as a popular and developed objective method to quantify the CAD severity through the coronary an giographic findings. Material and Method: In this retrospective cross-sectional study, researchers consecutively enrol a consecutive total of 171 patients referred to the Indonesian Navy Hospital of Dr Ramelan, who underwent elective coronary angiography from January to June 2019. Researchers divided the study population into three groups of low-rank military personnel, high-rank military personnel, and the civilian. Anthropometric, laboratory finding, and Gensini score were obtained from medical records. Results: This research found that Post-hoc LSD test analysis showed the average score of Gensini Score of high-rank military personnel (18.39 ± 32.71) is significantly lower than both low-rank (32.76 ± 41.84; p=0.031) and civilian (36.08 ± 43.41; p=0.005). Conclusions: High-rank military personnel was found to have lower Gensini score compared to low-rank and civilian