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.

Aim. To compare the relative expression levels of circulating microRNAs associated with cardiovascular diseases, selected according to the literature review, in the blood plasma samples of patients with two variants of chronic vascular wall injury: coronary artery atherosclerosis (CAA) and thoracic aortic aneurysm (TAA).Material and methods. Patients admitted to the Clinical Center of the I. M. Sechenov First Moscow State Medical University (University Clinical Hospital No. 1) with CAA (n=45), TAA (n=38), as well as a control group (n=17) were included. Standard clinical and demographic, laboratory and instrumental data were collected in accordance with Russian clinical guidelines, and additional sampling and preparation of blood plasma of patients was carried out with further quantitative determination of the circulating microRNAs level via real-time polymerase chain reaction with reverse transcription. A comprehensive comparative analysis of the profiles of circulating microRNAs in the blood plasma of patients with two different variants of arterial pathology: atherosclerosis and aneurysmal changes, as well as with the control group was carried out. The levels of 12 circulating microRNAs were studied: miR-21-5p, -23a-3p, -29b-3p, -92a-3p, -126-5p, -143-3p, -145-5p, -146a-5p, -150-5p, -181b-5p, 2-23-3p and -451a.Results. The strongest difference with the control group in patients with CAA and TAA was observed for miR-21-5p, -29b-3p and -126-3p. Most of the circulating microRNAs studied were higher in the TAA group compared with CAA and controls these include miR-21-5p, -23a-3p, -29b-3p, -92a-3p, -126-3p, -126-5p, -146a-5p, -150-5p, -181b-5p. Significant differences between the pathology groups were noted for miR-126-3p and miR-205-5p. Some microRNAs (­miR-143-3p, -92 a3, -195-5 p) can be used to diagnose coronary artery atherosclerosis, other microRNAs (miR-21-5p, -23a-3p, -126-3p, -126-5p, -451a) are TAA-specific.Conclusion. The present study showed significant differences in the circulating microRNAs in patients with atherosclerotic and aneurysmal lesions of the arteries in comparison with the control group. The most significant difference between norm and pathology was found for miR-21-5p, -29b-5p and -126-3p. The levels of miR-126-3p and -205-5p can be used to differentiate CAA and TAA.

Objective. To evaluate a new model of risk factor-weighted clinical likelihood (RF-CL) in diagnosis of chronic coronary syndrome (CCS) taking into account gender differences. Material and methods. The registry study included 69 men and 62 women (age 66.8±10.2 years) who were examined for suspected coronary artery disease. All patients with various risk factors and clinical manifestations of CCS underwent diagnostic searching in accordance with the Russian guidelines “Stable coronary artery disease” (2024), as well as analysis of clinical likelihood of coronary artery disease using the RF-CL model was performed. Results. When comparing clinical likelihood of obstructive coronary artery disease according to RF-CL data, men showed higher values compared to women (21.6±12.6% and 8.2±5.9, respectively, p15—50%) for men and women — 68% and 11% (p5—15%) — 27% and 58% (p<0.001), very low (RF-CL≤5%) — 4% and 31%, respectively (p<0.001). The prevalence of typical (28% vs. 20%, p=0.39) and atypical angina (21% vs. 25%, respectively, p=0.67), as well as non-cardiac chest pain (31% vs. 23%, p=0.4) did not differ between groups. However, dyspnea was more common among women (39% vs. 66%, p=0.005). Only 17 (13%) ones who underwent stress test had indications for invasive coronary angiography. At the same time, 10 (8%) patients had stenoses ≥70%. Conclusion. A new RF-CL model on a small cohort demonstrates the need for its use on a larger sample, as it emphasizes excessive number of stress tests (especially for women) in case of adherence of attending physicians to traditional Diamond–Forrester pre-test probability algorithm.

Objective. To identify gender differences using a new clinical probability model for chronic coronary syndrome (CCS) based on risk factor-weighted clinical likelihood (RF-CL) and traditional Diamond-Forrester CAD pre-test probability model (PTP DF model). Material and methods. The registry study included 144 men (mean age 64.7±10.2 years) and 93 women (mean age 67.3±9.4 years) who were examined for suspected CCS. Diagnosis of CAD was carried out in accordance with current (2024) Russian guidelines «Stable coronary artery disease» [6]. Additionally, we calculated clinical probability of obstructive CAD using the RF-CL model. Results. Clinical likelihood of CCS based on new RF-CL model was higher in men (17% vs. 7%; p<0.001). Men were more often assigned to the group with moderate likelihood of CCS according to RF-CL than women (64% vs. 13%; p<0.001). However, women prevailed in group with low and very low likelihood (p<0.001). Comparative analysis of clinical manifestations of CCS between men and women revealed no significant differences in prevalence of typical angina (25% vs. 20%, p=0.41), atypical angina (21% vs. 29%, p=0.15), non-cardiac chest pain (33% vs. 25%, p=0.19) and dyspnea (42% vs. 29%, p=0.15). After stress testing, 37 positive results and 74 negative results were obtained in men. In the group with positive results, men were significantly more likely to have moderate probability according to the RF-CL model (86% vs. 53%, p0.05). According to clinical data and stress testing, 45 (31%) men and 7 (7%) women were referred for invasive coronary angiography (ICA). When comparing the probabilities of obstructive CAD based on RF-CL and PTP DF model with ICA data, we obtained no significant differences between new and traditional models (p>0.05). Conclusion. In our cohort of patients, the RF-CL clinical probability model did not demonstrate any advantages over traditional DF model of coronary artery disease in men and women.