New Risk Factor-Weighted Clinical Likelihood (RF-CL) in Diagnosis of Chronic Coronary Syndrome in Men and Women: Our First Impressions About the Differences and Opportunities.

Background/

Objectives

To evaluate the Risk Factor-Weighted Clinical Likelihood (RF-CL) model for the diagnosis of chronic coronary syndrome (CCS) in men and women.

Methods

The study included 222 patients (100 men and 122 women; mean age 64.76 ± 10.3 years) with suspected CCS. Diagnostic evaluation was performed in accordance with the 2024 clinical practice guidelines for stable coronary artery disease developed by the Russian Society of Cardiology. The clinical probability of obstructive coronary artery disease (CAD) was calculated for all patients using the RF-CL model.

Results

Application of the RF-CL model demonstrated higher probabilities in men than in women (17% [11-27] vs. 6% [4,5,6,7,8,9,10], p < 0.001). Moderate CCS probability (RF-CL > 15-50%) was observed in 64% of men and 9.8% of women (p < 0.001); low probability (RF-CL > 5-15%) in 30% and 60.7% (p < 0.001); very low (RF-CL ≤ 5%) in 6% and 29.5% (p < 0.001). The prevalence of typical angina (21% vs. 17.2%, p = 0.47), atypical angina (31% vs. 26.2%, p = 0.43), and non-anginal chest pain (31% vs. 26.2%, p = 0.43) did not differ. Dyspnea was less frequent in men (44% vs. 59.8%, p = 0.02). Only 35 (15.8%) patients had indications for invasive coronary angiography (ICA), and significant stenosis (≥70%) was found in 17 patients. According to the ROC analysis, the cutoff value of RF-CL for predicting a positive stress test was 19.5% in men (AUC 0.723; p = 0.002), 6.5% in women (AUC 0.479; p = 0.852), and 15% in the overall cohort (AUC 0.737; p < 0.0001).

Conclusions

Men with moderate and women with low probability of obstructive CAD are predominantly encountered in clinical practice when the RF-CL model is applied. Our observations have shown that ICA is indicated in relatively few patients and suggest potential overuse of exercise testing regardless of the clinicians' adherence to the traditional Diamond-Forrester model or the RF-CL algorithm in suspected CCS.