Coronary Artery Disease Scores

2024 ESC RF-CL Calculator – Obstructive Coronary Artery Disease Likelihood

Clinical calculation support · Verify results before clinical use

Clinical likelihood assessment

Enter the patient's clinical characteristics to estimate the likelihood of obstructive coronary artery disease.

—Likelihood
1

Patient characteristics

The published RF-CL matrix covers ages 30–80 years.

2

Presenting symptom

Select the primary symptom. Exertional dyspnoea as the primary symptom is assigned 2 symptom points.

Chest pain characteristics

Each characteristic contributes 1 point. The symptom score is the sum of the selected characteristics (0–3).

3

Coronary artery disease risk factors

Select all risk factors present at the time of assessment.

Premature family history: at least one first-degree relative with early CAD (men younger than 55 years; women younger than 65 years).

—RF-CL (%)
Estimated clinical likelihood
Complete patient inputs
The estimate will appear when valid inputs are provided.
Clinical interpretation

This model estimates the initial pre-test likelihood of obstructive CAD. It does not establish a diagnosis.

RF-CL is not a substitute for clinical assessment. Consider other clinical findings and comorbidities when determining the need for further evaluation.

About the RF-CL model

The 2024 ESC Risk Factor-weighted Clinical Likelihood (RF-CL) model estimates the initial clinical likelihood of obstructive epicardial coronary artery disease in patients with suspected chronic coronary syndromes.

It combines age, sex, symptom characteristics and the number of five coronary risk factors. The published matrix reports likelihood estimates for age bands from 30 to 80 years.

Symptom score

  • Chest pain: one point for each of the three defined characteristics (0–3 points).
  • Exertional dyspnoea as the primary symptom: 2 points.

Risk factor definitions

  • Family history: at least one first-degree relative with early CAD (men <55 years; women <65 years).
  • Smoking: current or past smoker.
  • Dyslipidaemia, hypertension and diabetes: present at the time of diagnosis.

Clinical likelihood categories

LikelihoodEstimated probability
Very low≤5%
Low>5% to 15%
Moderate>15% to 50%

The unadjusted RF-CL matrix produces estimates up to 45%. High and very high categories are not generated by this matrix.

References

Vrints C, Andreotti F, Koskinas KC, et al.2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415–3537. DOI: 10.1093/eurheartj/ehae177.
Winther S, Schmidt SE, Mayrhofer T, et al.Incorporating Coronary Calcification Into Pre-Test Assessment of the Likelihood of Coronary Artery Disease. J Am Coll Cardiol. 2020;76(21):2421–2432. DOI: 10.1016/j.jacc.2020.09.585.
Winther S, Murphy T, Schmidt SE, et al.Performance of the American Heart Association/American College of Cardiology Guideline-Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease. J Am Heart Assoc. 2022;11(24):e027260. DOI: 10.1161/JAHA.122.027260.
Clinical disclaimer: This calculator is an educational clinical decision-support tool. RF-CL estimates the initial likelihood of obstructive epicardial CAD and does not diagnose CAD, myocardial ischaemia, or ANOCA/INOCA. It should not be used as the sole basis for decisions. Interpret the result alongside the clinical presentation, ECG, echocardiography, comorbidities, patient preferences and applicable guideline recommendations.
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