title: Analysis of three risk stratification systems in a Saudi population.
abstract: BACKGROUND
  Coronary artery disease is the leading cause of death worldwide. Although there are a number of algorithms in use for determining the risk of coronary artery disease and thus predicting future cardiovascular events, the data available regarding their validity among the Saudi population are insufficient.
  
  
  OBJECTIVE
  We studied the validity of three clinical score systems in predicting a high risk population defined as having excessive coronary calcification: the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation, the Framingham Risk Score, and the European Systematic Coronary Risk Evaluation.
  
  
  METHODS
  We analyzed data from 462 patients aged ⩾40 years. High-risk features were if the Coronary Calcium Score was either >400 or in the ⩾75th percentile using Multi-Ethnic Study of Atherosclerosis (MESA) score. The scores for the three algorithms were then calculated using the participants' clinical data.
  
  
  RESULTS
  A total of 87 (18.8%) patients were positive for coronary calcification. Among them, 60 (13%) were classified as being at high risk according to the MESA score. Analyzing these patients by the ACC/AHA Pooled Cohort Risk Equation resulted in nine (15%) as being at low risk, 12 (20%) at intermediate risk, and 39 (65%) at high risk. The Framingham Risk classification resulted in 14 (23%) being at low risk, 13 (22%) at intermediate risk, and 33 (55%) at high risk. The European Systematic Coronary Risk Evaluation risk classification showed 24 (40%) at low risk, 12 (20%) at intermediate risk, and 24 (40%) at high risk, withp< 0.0001.
  
  
  CONCLUSIONS
  The ACC/AHA Pooled Cohort Risk Equation has superior risk ​ calibration compared to the other two risk-score algorithms in a Saudi population.
authors.affiliation: Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center-Qassim (PSCCQ), King Fahad Specialist Hospital, Buraydah, aSaudi Arabia.
authors.forename: Rami
authors.initials: R
authors.lastname: Abazid
authors.affiliation: Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center-Qassim (PSCCQ), King Fahad Specialist Hospital, Buraydah, aSaudi Arabia.
authors.forename: Hanna
authors.initials: H
authors.lastname: Al Saqqa
authors.affiliation: Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center-Qassim (PSCCQ), King Fahad Specialist Hospital, Buraydah, aSaudi Arabia.
authors.forename: Osama
authors.initials: O
authors.lastname: Smettei
keywords: ACC/AHA Pooled Cohort Risk Equation; Framingham Risk Score; Multi-Ethnic Study of Atherosclerosis score