Enhanced risk stratification scale for predicting death and non-fatal cardiovascular events in patients of the PROGNOZ IBS registry

Abstract

Aim. To develop a risk stratification scale for predicting cardiovascular events (CVEs) in patients with chronic coronary artery disease (CAD) based on the data from the PROGNOZ IBS registry.Material and methods. The PROGNOZ IBS registry included 641 patients (men, 500; women, 141) living in Moscow and the Moscow Region, who were routinely admitted to the National Medical Research Center for Therapy and Preventive Medicine from January 1, 2004 to December 31, 2007 with a preliminary diagnosis of CAD. All included participants underwent coronary angiography during hospitalization. The diagnosis of CAD was verified in 84% of patients. The vital status was established in 551 (86%) patients in 2010 and 583 (92%) in 2014. The follow-up period was 7 years. A multivariate statistical analysis of the predictive value of data obtained during primary hospitalization was carried out.Results. The enhanced risk stratification scale included factors with the highest predictive value for developing CVEs. The presence of NYHA class III-IV heart failure increased the relative risk of CVEs by 5,4 times (3 points), atherosclerotic aortic stenosis by 2,8 times (2 points), stroke by 2,3 times (3 points), a confirmed diagnosis of CAD by 1,7 times (1  point), the presence of dyspnea by 1,4 times (1 point), unstable CAD course in the last 3 months by 1,4 times (1 point), taking diuretics before hospitalization by 1,9 times (1 point), left ventricular ejection fraction of 40-60% and left ventricular diastolic dysfunction according to echocardiography by 1,9 and 2 times (1 point each), respectively, an increase in the heart rate according resting electrocardiography >90 bpm by 1,7 times (1 point), the presence of chronic lung disease or renal failure by 1,5 times (1 point). Seven-year risk of fatal and nonfatal CVEs in patients with CAD in case of score of 0-3 is considered low, score of 4-5 points — moderate (increase in CVE risk by 3 times), score of ≥6 — high (increase in CVE risk by 9 times).Conclusion. The enhanced risk stratification scale allows predicting the risk of fatal and non-fatal CVC in patients with suspected and confirmed CAD and may be used for widespread use due to informative value, simplicity and availability.