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      Using the Gensini score to estimate severity of STEMI, NSTEMI, unstable angina, and anginal syndrome

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          Abstract

          Gensini score (GS) provides valuable information on severity and prognosis of coronary artery disease (CAD).

          To evaluate the relationship between the severity of CAD determined by the GS and relation to ST-elevation myocardial infarction, non-ST segment elevation myocardial infarction (NSTEMI), unstable angina pectoris, chest pain (suspected angina syndrome on admission) and risk-factors for CAD and predictors of severity.

          Observational cross-sectional study.

          Consecutive patients who underwent clinically-indicated coronary angiography for ST-elevation myocardial infarction, NSTEMI, unstable angina pectoris or chest pain were enrolled.

          Among 600 patients, 417 (average age 67.8 ± 12.2 years) had CAD–related symptoms. Mean GS was 66.7 ± 63.8. Patients presenting with NSTEMI had the highest GS (81.3 ± 42.3; P < .001) Regression analysis of risk-factors showed the best association of GS with multivessel disease and coronary artery bypass graft. Regression analysis of medications showed that clopidogrel, had the best association with low GS.

          GS correlated with the severity of CAD, multivessel disease, coronary artery bypass graft, and troponin. GS was related to the cardiovascular risk-factors of diabetes, hypertension, and high-density cholesterol.

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          Most cited references21

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          Diabetes and cardiovascular disease. The Framingham study.

          Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was reported. The relative impact was greatest for intermittent claudication (IC) and congestive heart failure (CHF) and least for coronary heart disease (CHD), which was, nevertheless, on an absolute scale the chief sequela. The relative impact was substantially greater for women than for men. For each of the cardiovascular diseases (CVD), morbidity and mortality were higher for diabetic women than for nondiabetic men. After adjustment for other associated risk factors, the relative impact of diabetes on CHD, IC, or stroke incidence was the same for women as for men; for CVD death and CHF, it was greater for women. Cardiovascular mortality was actually about as great for diabetic women as for diabetic men.
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            Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease.

            The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians ans integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's judgment and may assit in decisions on cost effectiveness of tests.
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              A more meaningful scoring system for determining the severity of coronary heart disease.

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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                15 October 2021
                15 October 2021
                : 100
                : 41
                : e27331
                Affiliations
                [a ]Meir Medical Center, Kfar Saba, Israel
                [b ]Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
                [c ]Department of Cardiology, Kaplan Medical Center, Rehovot, Israel.
                Author notes
                []Correspondence: Gideon Charach, Department of Internal Medicine B, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 4428164, Israel (e-mail: drcharach@ 123456012.net.il ).
                Article
                MD-D-21-02743 27331
                10.1097/MD.0000000000027331
                8519204
                34731103
                ebec39fe-160b-4203-94a6-b93fa1a4c993
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 7 April 2021
                : 11 August 2021
                : 8 September 2021
                Categories
                3400
                Research Article
                Observational Study
                Custom metadata
                TRUE

                atherosclerosis,coronary angiography,coronary artery disease,gensini score

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