The Role of Cardiovascular Risk Factors and Risk Scoring Systems in Predicting Coronary Atherosclerosis

Abstract Background Comparative data on the performance of cardiovascular risk scoring systems (CRSSs) in patients with severe coronary artery disease (CAD) are lacking. Objectives To compare different CRSSs regarding their ability to discriminate patients with severe CAD. Method A total of 414 patients (297 men; 61.3±12.3 years of age) undergoing coronary angiography were enrolled and evaluated for major risk factors. Cardiovascular risk and risk category were defined for each patient using the Framingham, Systemic Coronary Risk Evaluation (SCORE), and Pooled Cohort Risk Assessment Equation (PCRAE) tools. Severe CAD was defined as ≥ 50% stenosis in at least one major coronary artery and/or previous coronary stenting or coronary artery bypass grafting. A p < 0.05 was considered statistically significant. Results Severe CAD was identified in 271 (65.4%) patients. The ROC curves of the 3 CRSSs for predicting severe CAD were compared and showed no significant difference: the area under the ROC curve was 0.727, 0.694, and 0.717 for the Framingham, SCORE, and PCRAE tools, respectively (p > 0.05). However, when individual patients were classified as having low, intermediate, or high cardiovascular risk, the rate of patients in the high-risk group was significantly different between the PCRAE, Framingham, and SCORE tools (73.4%, 27.5%, and 37.9%, respectively; p < 0.001). Discussion PCRAE had higher positive and negative predictive values for detecting severe CAD in high-risk patients than the Framingham and SCORE tools. Conclusion We can speculate that currently used CRSSs are not sufficient, and new scoring systems are needed. In addition, other risk factors, such as serum creatinine, should be considered in future CRSSs. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic Ischemia Grade in STEMI / Associação entre a Relação Neutrófilos/Linfócitos e o Grau de Isquemia Eletrocardiográfica no IAMEST

Background: Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI. Objective: To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification. Methods: Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I). Results: Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001). Conclusion: We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores. .

Fundamento: A relação neutrófilos/linfócitos (N/L) tem sido descrita como boa preditora de eventos cardiovasculares adversos futuros em pacientes com infarto agudo do miocárdio com elevação do segmento ST (IAMEST). Mudanças na porção terminal do complexo QRS também têm sido associadas a eventos adversos após IAMEST. Objetivo: Investigar a associação entre o grau de isquemia no ECG e a relação N/L em pacientes com IAMEST para determinar fatores de risco convencionais adicionais na estratificação precoce de risco. Métodos: Pacientes com IAMEST foram investigados. O grau de isquemia foi analisado a partir do ECG obtido à admissão. A contagem de leucócitos e seus subtipos foi realizada a partir de hemograma automatizado. De acordo com o grau de isquemia presente no ECG de admissão, os pacientes foram classificados em dois grupos, isquemia grau 2 (IG2) e isquemia grau 3 (IG3). Resultados: Pacientes com IG3 apresentaram valores médios significativamente menores de fração de ejeção do ventrículo esquerdo do que os pacientes com IG2 (44,58 ± 7,23 versus 48,44 ± 7,61; p = 0,001). Como esperado, a taxa de mortalidade intra-hospitalar aumentou proporcionalmente com o aumento no grau de isquemia (p = 0,036). Houve diferenças significativas nas porcentagens de linfócitos (p = 0,010) e de neutrófilos (p = 0,004) e, portanto, a relação N/L diferiu significativamente entre pacientes com IG2 e IG3 (p < 0,001). À análise de regressão logística multivariada, apenas a relação N/L emergiu como variável independente com efeito significativo sobre o grau de isquemia no ECG (odds ratio = 1,254; intervalo de confiança de 95% 1,120-1,403; p < 0,001). Conclusão: Nós encontramos uma associação entre IG3 e relação N/L aumentada em pacientes com IAMEST. Acreditamos que esta associação possa oferecer um valor prognóstico adicional para estratificação de risco em pacientes com IAMEST quando usado em combinação com escores de risco padronizados. .