Framingham Risk Score for the prediction of coronary artery disease in patients with chronic rheumatic heart disease

BACKGROUND: Patients with chronic rheumatic heart disease (CRHD) have concomitant coronary artery disease (CAD), but the model to detect coexistent coronary artery stenosis prior to surgery has not been validated. Our study investigated whether the Framingham Risk Score (FRS) is a valid predictor of CAD in patients undergoing surgery for CRHD. METHODS: A total of 989 rheumatic patients were enrolled between 2005 and 2010. They were subdivided into two groups according to coronary angiography (CAG) results to identify potential factors in the development of CAD. Finally, all patients were assessed using the FRS to examine the association between the 10-year cardiovascular disease (CVD) risk and CAD. RESULTS: There were statistically significant inter-group differences in terms of age, sex, smoking, hypertension, bypass surgery and cardiac function in the New York Heart Association (NYHA) classification status (p<0.05). We showed that the FRS had high accuracy in predicting CAD in female and male patients with CRHD. In the male group, the area under the curve (AUC) for predicting CAD was 0.904, with a specificity of 90.3% and sensitivity of 76.1%. In the female group, the AUC for predicting CAD was 0.924, with a specificity of 77.5% and sensitivity of 90.9%, respectively. With a cut-off point of a 10-year CVD risk of 12.5 (%) in the male group and a 10-year CVD risk of 2.5 (%) in the female group, the FRS identified 746 low-risk patients, including 11 (4.3%) with CAD in the male group and 4 (0.8%) with CAD in the female group. None of the patients needed an indication for coronary artery bypass grafting (CABG). CONCLUSIONS: The FRS model can accurately predict the prevalence of significant CAD and can reliably identify low-risk patients in whom routine pre-surgical angiography could be avoided.