A novel clinical risk prediction model for myocardial infarction, coronary revascularization, and cardiac death according to clinical, exercise, and gated SPECT variables (VH-RS). (3rd May 2019)

• Record Type: Journal Article
• Authors: Romero-Farina, Guillermo; Candell-Riera, Jaume; Aguadé-Bruix, Santiago; García Dorado, David
• Is Part Of: European heart journal. Volume 21:Number 2(2020)
• Page Start: 210
• Page End: 221
• Publication Date: 2019-05-03
• Subjects: risk score -- exercise test -- gated SPECT -- myocardial infarction -- coronary revascularization -- cardiac death; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jez078
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: To create a risk score for cardiac events (CE) according to clinical, exercise, and gated SPECT variables. Methods and results: We analysed 5707 consecutive patients; 3181 patients (age 64.2 ± 11 years, male 59.6%) with suspected coronary artery disease (CAD) [without previous myocardial infarction (MI) or coronary revascularization (CR)] and 2526 patients (age 63.3 ± 11 years, male 81.7%) with established CAD (with previous MI or CR). To create the Vall d'Hebron Risk Score (VH-RS), first we analyse the predictors of CE (non-fatal MI, CR, and/or cardiac death), then the probability of CE for every patient according to the predictive variables. According to risk we stratified patients into four risk levels: very low risk (VLR), low risk (LR), moderate risk (MR), and high risk (HRi) using Multiple Cox Regression analysis models. Finally, we validate the VH-RS in another prospective cohort of 734 patients. In patients with suspected CAD; age ( P < 0.001); gender ( P = 0.001); hyperlipidaemia ( P < 0.001); nitrates ( P = 0.04); ejection fraction (EF) ( P = 0.001); summed stress score ( P < 0.001); METs ( P < 0.001); exercise angina ( P = 0.006); and mm of ST segment depression ( P = 0.004) were the independent predictors of CE (C-statistic: 0.8; P < 0.001). In patients with established CAD, EF ( P < 0.001); summed difference score ( P = 0.001); age ( P < 0.001); smoker ( P = 0.002); nitrates ( P = 0.003); exercise angina ( P = 0.001); METs ( P < 0.001); and mm of ST segment depression ( P = 0.011) were the independent predictors of CE (C-statistic: 0.7; P < 0.001). The risk score obtained from these variables allows the stratification of patients into four risk levels: VLR, LR, MR, and HRi. Conclusions: The cardiac risk stratification by mean of clinical, exercise, and gated SPECT variables is an objective aid to assessing an individual's cardiac risk.