Study On Establishment Of Scoring Model For Suspicious Coronary Heart Disease And Evaluation Of The Clinical Value

Objective:1. This study was performed to build a simple and easy scoring model forpatients with suspicious coronary heart disease to assess the degree of coronary arterystenosis and test the clinical value of the scoring model.2. To explore the relationship between scoring model and the severity ofcoronary lesions (Gensini score).Methods:This was a retrospective study. There were318subjects which were selectedfrom the department of cardiology in the first hospital of Jilin University from March2014to February2015. All patients underwent coronary angiography. We recordedtheir age, sex, smoking history, drinking history, hypertension, diabetes, heart rate. Onthe second morning their blood biochemical makers were measured: the lipid indices(TG, TC, LDL-C, HDL-C), FPG, creatinine, fibrinogen, bilirubin, MPV, PDW, ECGand echocardiography used to measure the score of LVEF. The study was divided intothree parts.1. Establishing the scoring model. According to the results of coronaryangiography (CAG), patients were divided into two groups (non-CHD group andCHD group). We analyzed their clinical data between the two groups and selectedrisk factors by logistic regression analysis. Then risk factors were assigned accordingto OR values. The scoring model was built.2. Evaluating the clinical value of scoring model. According to this model, everypatient’s risk points were calculated. We used receiver operating characteristic (ROC)curve to determine the scoring model’s feasibility and accuracy. According to cutoffpoint, all patients were classified as high-risk patients and low-risk patients.3. Exploring the relationship between scoring model and the severity of coronary lesions and analyzing the relationship between the clinical parameters and theseverity of coronary lesions. According to the results of CAG, We calculated thepatients’ Gensini score. Using linear correlation, we tested the relationship betweenthose clinical factors and Gensini score.Results:1.Compared with the contrast, the group CHD had an higher level of age,smoking history, drinking history, hypertension, creatinine, fibrinogen, FPG, TG, TC,LDL-C, statistical analysis P<0.05; an lower level of LVEF（%）,statistical analysisP<0.05. During the two groups, there were no differences of sex(male), diabetes,heart rate、MPV, PDW, bilirubin, HDL-C、ECG，statistical analysis P>0.05.2. In the first part, we found eleven factors which were different in two groups.We further studied these factors with logistic multivariate regression model. Smokinghistory, TG, age，hypertension, fibrinogen were the risk factors for CHD．Accordingto the odds ratio (OR), we assigned to these risk factors, built a scoring model, andcalculated every patient’s risk points. For the diagnostic scoring model，the area underthe ROC curve was0.710, sensitivity=75.0%, specificity=57.5%. The cutoff pointwas3.5points. Based on this scoring system patients were divided into high-riskgroup and low-risk group. When risk scores≥3.5points, it is needed for coronaryangiography. For the low-risk group (<3.5points), the patients can firstly do coronaryCT examination.3. The patient’s risk score of scoring model was linearly correlated with theGensini score, linear correlation equation: Y (Gensini score)=1.275+3.845X (riskscore), r=0.313. The factors（age, smoking history, drinking history, hypertension,creatinine, fibrinogen, FPG, TG, TC, LDL-C）and Gensini scores were positivelycorrelated, statistical analysis P <0.05. LVEF(%) and Gensini Points were negativelycorrelated，statistical analysis P <0.05. There was no significant relationship betweenthe Gensini score and the clinical indicators: sex (male), diabetes, heart rate, bilirubin,MPV, PDW, HDL-C, electrocardiogram (abnormal), statistical analysis P>0.05. Themost relevant factors of four were: smoking history, TG, age, fibrinogen. Conclusion:1.The scoring model is simple and practical. It can be used to evaluate thepatients’ degree of coronary artery stenosis in moderate accuracy.2. The patient’s risk score of scoring model was linearly correlated with theGensini score. The scoring model can be used for preliminary assessment of theseverity of coronary lesions.