Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study

AIM

Coronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP.

METHODS

This single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA₂DS₂-VASc, M-CHA₂DS₂-VASc, CHA₂DS₂-VASc-HS, R₂-CHA₂DS₂-VASc, M-R₂-CHA₂DS₂-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP.

RESULTS

The mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA₂DS₂-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2-3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA₂DS₂-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001).

CONCLUSION

We showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA₂DS₂-VASc-HS score had the best discriminative ability.

Gender-Dependent Comparison of Coronary Computed Tomography Angiographic Characteristics among Patients with Suspected Atherosclerosis: A Single-Center Experience

OBJECTIVE

In this study, we aimed to examine gender-based differences in coronary artery disease (CAD) risk factors, the presence and severity of atherosclerosis, and the distribution of plaque type in patients presenting with chest pain.

METHODS

A total of 1496 patients who applied to our cardiology outpatient clinic with chest pain and underwent computed coronary tomographic angiography (CTA) between August 2020 and October 2021 were included in the study. Plaque characteristics, Agatston score, and Coronary Artery Disease-Reporting and Data System (CAD-RADS) score obtained from the patients' CTAs were compared by gender.

RESULTS

Of the 1496 patients evaluated, 47.9% were female. Coronary atherosclerosis was detected in 35.4% of females and 52.9% of males (P <0.001). Diabetes mellitus [155 (21.8%) vs. 123 (15.7%); P <0.001] and hypertension [271 (38.1%) vs. 249 (32%); P <0.001] rates were higher in females than in males. Plaque burden and high-risk plaque rate were found to be higher in males (P <0.001). Next, the rate of moderate-to-high coronary artery stenosis (CAD-RADS ≥3) was observed at 21.6% in men and 12.2% in women (P <0.001). Agatston score was found to be higher in males than in females for all age groups (P <0.001). The severity of CAD increased sharply with age in females (P interaction = 0.003).

CONCLUSION

Although female patients demonstrated higher rates of traditional risk factors, the male gender was associated with increased coronary plaque burden, high-risk plaque, CADRADS, and Agatston scores. Therefore, patient-based approaches that consider gender-related differences could provide effective treatment and follow-up.