Predicting obstructive coronary artery disease in heart failure with reduced ejection fraction: A practical clinical score

• Published in: Revista portuguesa de cardiologia 2023-01, Vol.42 (1), p.21-28
• Main Authors: Albuquerque, Francisco, Oliveira, Afonso Félix, de Araújo Gonçalves, Pedro, Campante Teles, Rui, de Sousa Almeida, Manuel, Gonçalves, Mariana, Lopes, Pedro M., Cunha, Gonçalo J.L., Presume, João, Matos, Daniel, Madeira, Sérgio, Brito, João, Raposo, Luís, Mesquita Gabriel, Henrique, Mendes, Miguel
• Format: Article
• Language: English
• Subjects: Angiografia coronária; Coronary Angiography - adverse effects; Coronary artery disease; Coronary Artery Disease - complications; Cross-Sectional Studies; Doença arterial coronária; Heart Failure - complications; Heart failure with reduced ejection fraction; Humans; Insuficiência cardíaca com fração de ejeção reduzida; Invasive coronary angiography; Male; Pre-test probability; Predictive Value of Tests; Probabilidade pré-teste; Risk Factors; Stroke Volume; Ventricular Dysfunction, Left
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2021.09.020

Obstructive coronary artery disease (CAD) remains the most common etiology of heart failure with reduced ejection fraction (HFrEF). However, there is controversy whether invasive coronary angiography (ICA) should be used initially to exclude CAD in patients presenting with new-onset HFrEF of unknown etiology. Our study aimed to develop a clinical score to quantify the risk of obstructive CAD in these patients. We performed a cross-sectional observational study of 452 consecutive patients presenting with new-onset HFrEF of unknown etiology undergoing elective ICA in one academic center, between January 2005 and December 2019. Independent predictors for obstructive CAD were identified. A risk score was developed using multivariate logistic regression of designated variables. The accuracy and discriminative power of the predictive model were assessed. A total of 109 patients (24.1%) presented obstructive CAD. Six independent predictors were identified and included in the score: male gender (2 points), diabetes (1 point), dyslipidemia (1 point), smoking (1 point), peripheral arterial disease (1 point), and regional wall motion abnormalities (3 points). Patients with a score ≤3 had less than 15% predicted probability of obstructive CAD. Our score showed good discriminative power (C-statistic 0.872; 95% CI 0.834–0.909: p