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CARDIOVASCULAR JOURNAL OF AFRICA • Africa STEMI Abstracts, April 2018
4
AFRICA
Presenting Author
Name:
Menge Issa
Surname:
Kuria
Contact Number
+254729147006
Article
English Title
Determining the level of agreement for atherosclerotic cardiovascular disease risk stratification between coronary artery
calcium score and traditional cardiovascular risk models
Category
Acute Coronary Syndromes
English Abstract
Introduction:
Estimation of the risk of future cardiovascular (CV) events is an important step in the management of cardio-
vascular diseases. A number of CV risk tools are currently available for use such as the Framingham Risk Score (FRS), the
American College of Cardiology/American Heart Association (ACC/AHA) pooled cohort equations and the World Health
Organization /International Society of Hypertension (WHO/ISH) prediction charts. Unfortunately, none of the current avail-
able risk tools is based on Kenyan data or has been validated in Kenyans. This study therefore sought to compare the
accuracy of FRS and ACC/AHA in a Kenyan population. The risk estimates derived using these algorithms were correlated
with coronary artery calcium score (CACS), a well-established reliable predictor of future risk of CV events.
Objective:
To determine the level of agreement between coronary calcium score and traditional cardiovascular risk models
for coronary artery disease risk stratification in a multi-ethnic population at a tertiary institution in Kenya.
Design:
A cross-sectional study
Methods:
Data was collected retrospectively from the medical records of 200 patients referred to the Radiology depart-
ment for a CT coronary artery calcium score. However, only 190 patients met the inclusion criteria were included in the
analysis. Risk stratification comparisons were done according to CACS, FRS, ACC/AHA and WHO/ISH and the agreement
(Kappa) and correlation (spearman rho) between them were calculated. Statistical significance was set at p < 0.05, and
analyses were performed using the STATA 14.0 software.
Results:
There was poor agreement (Kappa >0.191) between CACS and the clinical CVD risk models. In relation to this,
83.6% of the intermediate risk group according to FRS were down-classified by CACS while 9.1% of the same cohort were
up-classified to high risk by CACS.
Conclusion:
The poor agreement between CACS and the clinical CVD risk scores suggests that the clinical CVD risk
tools currently used in our Kenyan population might be incorrectly stratifying risk in patients. A prospective study is needed
to help improve risk predictions and set appropriate population-wide thresholds that are necessary to facilitate better clini-
cal decision making.
Authors
Name &
Surname
Title
Expertise
Affiliation
Country
Menge
Kuria
Dr
Resident doctor in
Radiology
Aga Khan
University
Hospital, Nairobi
issa.kuria@aku.eduKenya
Sudhir
Vinayak
Prof.
Chairman,
Radiology
Department
Aga Khan
University
Hospital, Nairobi
sudhir.vinayak.aku.eduKenya