Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study
Isao Aburadani1, Kazuo Usuda1, Hisashi Sumiya2
1Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan.
Insights
The J-ACCESS risk model accurately predicts cardiac events in patients with coronary artery disease (CAD). This validation confirms its clinical utility for risk assessment in real-world practice.
Area of Science:
- Cardiology
- Medical Informatics
Background:
- Coronary artery disease (CAD) management relies on accurate risk prediction.
- The Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) is a Japanese risk model for CAD.
- Clinical validation of existing risk models is crucial for practical application.
Purpose of the Study:
- To clinically validate the accuracy of the J-ACCESS risk prediction model.
- To assess the J-ACCESS model's performance in a Japanese cohort outside its development database.
Main Methods:
- The J-ACCESS model was evaluated using data from the APPROACH registry.
- Key variables included age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus.
- Major cardiac events (cardiac death, myocardial infarction, heart failure hospitalization) were tracked over three years.
Main Results:
- 283 patients with suspected or confirmed CAD were analyzed.
- The J-ACCESS model's predicted event rate (9 events) was comparable to the observed rate (6 events) over three years (p=0.58).
- Left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were significant predictors in multivariate analysis.
Conclusions:
- The J-ACCESS risk model demonstrates clinical validity for predicting cardiac events in CAD patients.
- The model's predictive accuracy supports its applicability in routine clinical practice.
- This study confirms the J-ACCESS model's utility in a distinct patient cohort.
Background:
In patients with coronary artery disease (CAD), one of the risk models available in Japan was a multivariate risk prediction model based on a Japanese multicenter database: the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS). The aim of this study was to clinically validate the accuracy of this risk model.
Methods:
We evaluated the performance of the J-ACCESS model using data derived from the Assessment of the Predicted value of PROgnosis of cArdiaC events in Hokuriku (APPROACH) registry. Variables of age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus were included. The major cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure that required hospitalization. The patients were followed up for three years to compare between predicted risk and actual events.
Results:
We evaluated 283 patients with suspected or confirmed CAD receiving myocardial perfusion imaging using 99mTc-tetrofosmin between March 2009 and August 2011. Mean age was 68.9±10.1 years, mean eGFR 67.4±24.3mL/min/1.73m2, mean SSS 5.2±7.2, and mean LVEF 65.4±14.0%. Fourteen (4.9%) patients experienced major cardiac events including cardiac death in 4 patients (1.4%), non-fatal myocardial infarction in 1 patient (0.3%), and severe heart failure in 9 patients (3.2%), respectively. While SSS≥8, LVEF<50%, eGFR<45mL/min/1.73m2, and event risk≥10% were significant variables in survival analysis, multivariate proportional hazard analysis showed that only LVEF and eGFR were significant. The event rate estimated from the J-ACCESS model was comparable to the actual number of major cardiac events (9 and 6, respectively, p=0.58 by Chi-square test).
Conclusions:
The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice.
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