title: Assessing coronary disease in symptomatic women by the Morise score.
abstract: BACKGROUND
  Early identification of coronary artery disease (CAD) among symptomatic women is critical given their worse outcomes as compared to men. We evaluated the value of the Morise score, a simple clinical risk score, for the assessment for CAD as determined by computed tomography coronary angiography (CTCA) and compared it to the Diamond-Forrester risk assessment.
  
  
  METHODS
  One hundred forty women (mean age, 64±11 years) with chest pain syndromes and no known CAD referred for CTCA were analyzed. Patients were risk stratified for likelihood of CAD by Morise and Diamond-Forrester scores. The presence and degree of CAD were determined by CTCA and classified as normal, nonobstructive (<50% stenosis), or obstructive (>50% stenosis). Total coronary calcium was calculated based on Agatston scores.
  
  
  RESULTS
  When risk was assessed by Morise vs. Diamond-Forrester, 5% vs. 7% of women were stratified as low, 41% vs. 82% as intermediate, and 54% vs. 11% as high risk for CAD, respectively. CAD was present in 95 (68%) patients; 22 (16%) had obstructive CAD, and 73 (52%) had nonobstructive CAD. Morise scores significantly correlated with calcium scores (p<0.001) as well as the presence and degree of CAD (p<0.0001). Morise scores also demonstrated significantly higher accuracy (66% vs. 48%, p<0.005) and higher sensitivity (56% vs. 16%, p<0.001) but lower specificity (82% vs. 97%, p<0.05) when compared to Diamond-Forrester risk assessment.
  
  
  CONCLUSIONS
  The Morise score performed better than Diamond-Forrester for CAD risk assessment, which highlights the importance and power of a simple history and physical examination in determining women at risk for CAD.
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York 10016, USA. snh73@yahoo.com
authors.forename: Susie N
authors.initials: SN
authors.lastname: Hong
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Mieres
authors.forename: Jill E
authors.initials: JE
authors.lastname: Jacobs
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Parag
authors.initials: P
authors.lastname: Patel
authors.forename: Monvadi B
authors.initials: MB
authors.lastname: Srichai
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging; D002637:Chest Pain / Q000150:complications / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D004967:Estrogens / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D010808:Physical Examination; D017698:Postmenopause / Q000502:physiology; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D004967:Estrogens