Different scales for assessing adverse cardiovascular events for patients in daily practice: which one is better?
Authors: Marchenko O , Rudenko N , Vnukov O 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Coronary artery disease is the main cause of morbidity and mortality despite the effort of the healthcare system in different countries. There are numerous scores for estimation of developing adverse events we can use for patients. But it is the doctor`s discretion to select the scale.
Purpose. To calculate the risk of developing adverse events from the cardiovascular system for patients on different scales and compare it with the data obtained from additional examinations.
Methods. We examined 131 patients and calculated the risks of developing adverse events as for primary prevention patients on 3 scales, namely HeartScore (HS), Framingham Risk Score (FRS), and ASCVD Risk Estimator Plus. Patients were divided into 3 groups depending on coronary angiography results. Group A included patients without coronary lesion, group B – patients with non-stenotic coronary lesions or single-vessel disease, group C – patients with multivessel disease.
Results. Patients were divided into three groups : group A contained 30 patients, group B and C–35 and 66 patients respectively. The groups were comparable in age (p = 0.39), body mass index (p = 0.43), and comorbidities.
For the HS 9 patients (6,9%) had total cholesterol (TC) lower than 3 mmol/l and it was the reason for exclusion. For 7 patients (5.3%) the reasons to exclude for FRS was age (more than 79 years old) and very low TC (lower than 2.5 mmol/l). And 19 patients (14.5%) were excluded from calculated ASCVD Risk Estimator Plus due to age, low TC and low-density lipoprotein (LDL).
According to the HS no groups have low risk of developing adverse events. In group A patients with moderate risk (53.3%) prevailed. Group B contained half of patients with high risk (51.7 %). Group C had 41.4% patients with high risk and 43.1% patients with very high risk of developing adverse events.
FRS had dissimilar results in group A and showed that 73.3% of patients had low risk. Group B presented 34.5%, 41.4%, and 24.1% patients with low, moderate and high risk respectively. Group C had 41.4% of patients with moderate risk and 32.8% with high risk.
ASCVD Risk Estimator Plus showed the following results. The majority of patients (41.4%) had intermediate risk in group A. Group B represented the largest number of patients with high risk (46.7%). Group C contained the biggest group of patients with high risk (58.5%). Results are represented in Figure 1
Conclusion. All scales have certain limitations such as the level of TC, LDL, age. Nevertheless, the FRS showed the highest percentage of low risk for patients who did not have coronary artery disease. At the same time HS revealed the largest number of patients in group C with multivessels diseases. These patients had a high and very high risk of developing cardiovascular events (84.5% in total). ASCVD Risk Estimator Plus has no advantages from the Scores. An additional disadvantage is that a lot of patients were excluded from the calculation (14.5%).
Abstract Figure. Results of the different scores