Contemporary predictors of coronary artery disease in patients referred for angiography.
OBJECTIVE
Risk stratification is often used to determine the need and priority for coronary angiography. We investigated the contemporary value of Framingham and SCORE risk models, individual risk factors, B-type natriuretic peptide and high-sensitivity C-reactive protein (hs-CRP) in the current era of intensive risk management.


RESULTS
Coronary artery disease (CAD) was obstructive (>or=50% stenosis) in 328 of 539 patients referred for elective diagnostic coronary angiography (61%). Lower rates of smoking, more exercise and lower cholesterol were noted in those with angiographic CAD, compatible with risk factor modification in these patients. Framingham and SCORE were associated with CAD both in patients with and without prior cardiovascular disease (CVD). In multivariate analysis only age, male sex, diabetes, chest pain and prior CVD were independent predictors of CAD; odds ratio 1.74 per 10 years (95% confidence interval: 1.34-2.27), 5.48 (3.36-8.92), 2.57 (1.44-4.60), 1.69 (1.02-2.81) and 2.61 (1.65-4.12), respectively. Classification of disease was not improved by B-type natriuretic peptide or hs-CRP when added to conventional risk factors, although the latter seems to have value in patients without earlier CVD and low-density lipoprotein-cholesterol of less than 3.4 mmol/l; the adjusted odds ratio for hs-CRP >or=2 mg/l in this sub-group was 2.49 (1.12-5.51, P=0.024).


CONCLUSIONS
Framingham and SCORE risk models can be used in clinical practice to predict angiographic coronary disease although risk factor modification limits the predictive value of smoking, blood pressure, lipid profiles and cardiac biomarkers.
Clinical Trials and Evaluation Unit, Royal Brompton Hospital & National Heart and Lung Institute, Imperial College, London, UK. d.kotecha@rbht.nhs.uk
Dipak
D
Kotecha
Marcus
M
Flather
Michele
M
McGrady
John
J
Pepper
Gishel
G
New
Henry
H
Krum
David
D
Eccleston
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology*; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D014739:Victoria
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D002784:Cholesterol