Coronary Artery Disease Risk Prediction in Patients With Severe Aortic Stenosis: Development and Validation of the Aortic Stenosis-Coronary Artery Disease (AS-CAD) Score

• Published in: The American journal of cardiology 2023-10, Vol.205, p.134-140
• Main Authors: Dagan, Misha, Cheung, Kevin, Quine, Edward, Gard, Emma, Johnston, Rozanne, Barker, Suzannah, Gartner, Elisha, Htun, Nay Min, Stub, Dion, Walton, Antony S., Nanayakkara, Shane
• Format: Article
• Language: English
• Subjects: Angiography; Aorta; Aortic stenosis; Aortic valve; Blood pressure; Cardiology; Cardiovascular disease; cardiovascular risk; Complications; Computed tomography; Confidence intervals; Coronary artery disease; coronary computed tomography angiography; Coronary vessels; Diabetes; Diabetes mellitus; Health risks; healthcare cost; Heart; Heart diseases; Heart valves; Hypertension; Kidney diseases; Medical imaging; Morbidity; Patients; Regression analysis; Risk; Risk groups; Statistical analysis; Systolic pressure; transcatheter aortic valve; Vein & artery diseases; Ventricle
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.07.168

•The current gold standard invasive coronary angiography in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation workup is associated with peri-procedural risks and high healthcare expenditure.•We developed and validated AS–coronary artery disease score, a coronary artery disease risk prediction tool specific to patients with severe AS, to identify patients who could be triaged to undergo noninvasive computed tomography coronary assessment.•The application of AS–coronary artery disease in clinical practice could potentially reduce the need for invasive coronary angiography and associated risks and health care costs by up to 43% in the workup for transcatheter aortic valve implantation. Patients at a low risk of coronary artery disease (CAD) could be triaged to noninvasive coronary computed tomography angiogram instead of invasive coronary angiography, reducing health care costs and patient morbidity. Therefore, we aimed to develop a CAD risk prediction score to identify those who underwent transcatheter aortic valve implantation (TAVI) at a low risk of CAD. We enrolled 1,782 patients who underwent TAVI and randomized the patients to the derivation or validation cohort 2:1. The aortic stenosis–CAD (AS-CAD) score was developed using logistic regression, followed by separation into low- (score 0 to 5), intermediate- (6 to 10), or high-risk (>11) categories. The AS-CAD was validated initially through the k-fold cross-validation, followed by a separately held validation cohort. The average age of the cohort was 82 ± 7 years, and 41% (730 of 1,782) were female; 35% (630) had CAD. The male sex, previous percutaneous coronary intervention, stroke, peripheral arterial disease, diabetes, smoking status, left ventricular ejection fraction 35 mm Hg were all associated with an increased risk of CAD and were included in the final AS-CAD model (all p