Abstract 15495: Atherosclerotic Cardiovascular Risk Score as a Predictor of Coronary Artery Disease Burden in Stable Chest Pain

BackgroundAtherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the United States. Cost-effective screening of patients, particularly those with stable chest pain, toward angiographically significant coronary disease continues to be a challenge. Though the commonly used ASCVD risk calculator is validated to determine the risk of a future ASCVD event (coronary death, nonfatal MI and fatal or nonfatal stroke) in 10 years, it has not been associated with coronary angiography in these patients. We hypothesize that ASCVD risk score can predict angiographically significant CAD in patients with stable chest pain.MethodsRetrospective chart review from 2017 to 2018 identified 149 consecutive patients with stable chest pain without evidence of acute myocardial injury who had diagnostic coronary angiography performed. Exclusion criteriaprevious known history of CAD or coronary angiography, positive EKG changes or cardiac enzymes, and admission to an ICU. Each patient was classified as either ASCVD low risk (=10%) and each coronary was angiographically graded as normal (0), low (1), moderate (2) or severe (3) stenosis and a cumulative score for CAD burden was calculated.ResultsSeventy-two (48%) patients had low ASCVD risk score and seventy-seven (52%) had high ASCVD risk score. Thirty-three percent of patients with low ASCVD risk score were noted to have angiographically significant CAD (at least 1 vessel with moderate or severe CAD) compared to 53% of patients with a high ASCVD risk score (p-value0.015). A high ASCVD risk was also associated with more patients with 2 vessel disease (38% vs 21%, p-value0.025), higher mean number of vessels per patient with at least moderate CAD (1.15 vs 0.68, p-value0.018) and a higher cumulative CAD burden (5.27 vs 3.4, p-value 0.001) compared to patients with a low ASCVD risk.ConclusionsA high ASCVD risk score suggests angiographically significant CAD in patients with stable chest pain. However, a low ASCVD risk score does not exclude CAD. One third of the patients in the low ASCVD risk group had angiographically significant CAD. Subgroup analysis suggests very high ACSVD risk score (>30%) is associated with increased left main and multi-vessel coronary disease.