الفهرس 
Risk Score Systems Framingham Risk Score (FRS) and the Systematic Coronary RISK Evaluation (SCORE)Only 14 pages are availabe for public view
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Abstract
Summary
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in most industrialized nations throughout the world, responsible for enormous loss of human life involving huge expenditure globally. For this reason, cardiovascular risk score systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies as offering preventive drugs such as drugs to lower blood pressure and drugs to lower cholesterol levels.
Our study was conducted on 120 consecutive Egyptian patients presenting for Coronary CT angiography (CTA) using Cardiac Multislice Computed Tomography (MSCT) in Cairo, Egypt, during the period from January to June 2018.
In this study, we have concentrated mainly on 2 risk algorithms recommended by guidelines on CVD prevention, Framingham Risk Score (FRS) for coronary heart disease events and for cardiovascular events and the Systematic Coronary Risk Evaluation (SCORE). Risk Score Systems as FRS and SCORE are designed to evaluate the risk of cardiac events in 10-year time
We correlated their ability to predict such cardiac events by risk scoring systems to the results achieved by MSCT through detecting plaque burden, composition, distribution and the extent of coronary artery disease.
And about CAD diagnosis, it is generally believed that invasive coronary angiography (ICA) is considered to be the gold standard in evaluating CAD, but with the development of the 16-multi-detector CT (MDCT), a non-invasive approach of coronary CT angiography (CTA), it has been applied widely to avoid the complications of ICA.
Our study revealed the high prevalence of coronary atherosclerosis in the Egyptian population as MSCT detected the presence of coronary lesions in 53.3% of cases, 18.3% of them were with obstructive plaques (≥50% narrowing of lumen). Both CACS and MSCT coronary angiography showed a high prevalence of normal coronary arteries in low FRS and SCORE patients (57.6% and 72.7%, respectively), which decreased with the increase of FRS and SCORE risk categories. Similarly, an increase in the prevalence of high CACS and obstruction was observed with increasing FRS and SCORE risk.
Our study confirms the fact that 64-slice MSCT enables the accurate and noninvasive evaluation of significant coronary artery stenosis, and in addition to degree of luminal stenosis, MSCT provides insight into the presence, location, and composition of coronary artery plaques, particularly for proximal lesions.
About Coronary artery calcification, our study also revealed that it is intimately related to total plaque burden and we considered it as a strong predictor of coronary events, so adding CAC score to risk scores significantly improves the identification and prognostication of patients without known CAD as CACS exceeding 100 was observed in 16.6% of patients and exceeding 400 in 4% of patients. There was a relatively high frequency of proximal noncalcified plaques (n=36) out of 64 plaques whether being obstructive or non obstructive plaques.
We also concluded that although both scores had good specificity and positive predictive value, SCORE had a high predictive value for CAD than FRS. Our results showed that low SCORE risk category showed the least number of patients with significant CAD (1/22 = 4.5%), compared to those with low risk using FRS (7/85 = 8.2%), where high risk SCORE category included more patients with significant CAD (9/23 = 39%) and events, compared to patients with FRS high risk category (3/10 = 30%).
In conclusion, the use of risk score systems especially SCORE in primary health care units will add great benefit for early identification of people at risk of developing CAD to get advantage from early use of prevention techniques, also appropriate application of Coronary CT angiography may improve patients’ clinical outcomes and reduce mortality rate from coronary atherosclerosis.