Incorporation of Non-invasive, Contrast-free, and Minimal Radiation Parameters in the Diagnostic Modalities of Coronary Artery Disease

Background: Ischemic heart disease is the major cause of morbidity and mortality. The diagnosis of chronic coronary syndrome is a challenge as most of the diagnostic investigation are either invasive or involve radiation or contrast material. The aim of our study was to find a scoring system comprising diagnostic parameters which are non-invasive and involve minimal radiation or contrast material and yet have high diagnostic yield. Methods: In this non-randomized study conducted at KRL hospital Islamabad from Oct 2022 to Aug 2024, we took baseline characteristics and calculated Non Invasive, Minimal Radiation score (NIMR score) comprising risk factors, ETT, coronary calcium score and age of the patients, aged 18 and above. They then underwent CCTA to look for CAD. The association of the CAD with the score was checked using regression analysis on IBM SPSS version 26. Results: Out of total 150 participants, 60% were male, mean age with SD was 50.54 ± 7.82 and age ranged from 40-67 years. CAD was more prevalent in male and increased with increasing age. On Univariate analysis, NIMR score both as continuous variable and as categorical variable emerged as strong predictor of CAD (OR: 2.45, 95% CI: 1.84-3.25, pValue: 0.000) and (OR: 64.09, 95% CI: 14.53-282.74, pValue: 0.000) respectively. On multivariate analysis also the NIMR score was strong predictor of CAD both as continuous variable (OR: 2.43, 95%CI: 1.83-3.24, pValue: 0.000) and as categorical variable (OR: 67.11, 95%CI: 14.47-311.14, pValue: 0.000). Conclusion: In conclusion, NIMR score, which is non-invasive, with minimal radiation and no contrast material involvement is a strong predictor of CAD in low and intermediate risk patients and very applicable in day to day clinical practice.