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Coronary risk stratification of patients with newly diagnosed heart failure

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@article{290926a43ad14f989f8d9c6aef9d6f09,
title = "Coronary risk stratification of patients with newly diagnosed heart failure",
abstract = "Objective: Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.Methods: Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.Results: The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24{\%} and 27{\%} of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61{\%} of patients with a 15{\%} risk of having CAD, resulting in an estimated savings of 15{\%} of the cost and 21{\%} of the radiation.Conclusions: A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.",
keywords = "coronary artery disease, heartfailure",
author = "Hasselbalch, {Rasmus Bo} and Mia Pries-Heje and Thomas Engstr{\o}m and Andreas Sand{\o} and Merete Heitmann and Frants Pedersen and Morten Schou and Hans Mickley and Hanne Elming and Rolf Steffensen and Lars Koeber and Iversen, {Kasper Karmark}",
note = "{\circledC} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = "9",
day = "1",
doi = "10.1136/openhrt-2019-001074",
language = "English",
volume = "6",
pages = "e001074",
journal = "Open Heart",
issn = "2053-3624",
publisher = "BMJ Publishing Group",
number = "2",

}

RIS

TY - JOUR

T1 - Coronary risk stratification of patients with newly diagnosed heart failure

AU - Hasselbalch, Rasmus Bo

AU - Pries-Heje, Mia

AU - Engstrøm, Thomas

AU - Sandø, Andreas

AU - Heitmann, Merete

AU - Pedersen, Frants

AU - Schou, Morten

AU - Mickley, Hans

AU - Elming, Hanne

AU - Steffensen, Rolf

AU - Koeber, Lars

AU - Iversen, Kasper Karmark

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.Methods: Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.Results: The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation.Conclusions: A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.

AB - Objective: Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.Methods: Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.Results: The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation.Conclusions: A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.

KW - coronary artery disease

KW - heartfailure

UR - http://www.scopus.com/inward/record.url?scp=85073687087&partnerID=8YFLogxK

U2 - 10.1136/openhrt-2019-001074

DO - 10.1136/openhrt-2019-001074

M3 - Journal article

VL - 6

SP - e001074

JO - Open Heart

JF - Open Heart

SN - 2053-3624

IS - 2

M1 - e001074

ER -

ID: 58297946