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Published on: August 9, 2024
Predicting long-term ischemic events using routine clinical parameters in patients with coronary artery disease: The
Yaling Han1, Jiyan Chen2, Miaohan Qiu1
1General Hospital of Shenyang Military Region, Shenyang, China.
Insights
A new OPT-CAD score effectively predicts long-term ischemic events in coronary artery disease patients. This risk score outperforms the GRACE score, aiding personalized treatment decisions for better patient outcomes.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Pharmacotherapy
Background:
- Prognosis for coronary artery disease (CAD) patients at discharge varies, with ongoing concerns about post-discharge ischemic events.
- Existing risk prediction tools for identifying ischemia risk in these patients are lacking.
Purpose of the Study:
- To develop a scoring system for predicting long-term ischemic events in CAD patients on antiplatelet therapy.
- To aid personalized decision-making in managing antiplatelet therapy for CAD patients.
Main Methods:
- Prospective registry (OPT-CAD) of 14,032 Chinese CAD patients receiving antiplatelet agents.
- Development of a risk score using logistic regression in a derivation cohort (10,000 patients).
- Validation of the score in a separate cohort (4,032 patients), defining ischemic events as cardiac death, myocardial infarction, or stroke.
Main Results:
- The OPT-CAD score, based on 10 risk factors, showed good predictive performance (AUC 0.73 in derivation, 0.72 in validation).
- Incidences of 1-year ischemic events varied significantly by risk category: 1.6% (low), 5.5% (medium), and 15.0% (high).
- OPT-CAD score demonstrated superior discrimination for ischemic events and all-cause mortality compared to the GRACE score.
Conclusions:
- A risk score derived from 10 baseline clinical variables in CAD patients offers better prediction of long-term ischemic events than the GRACE score.
- Further research is warranted to evaluate the OPT-CAD score's utility in guiding antiplatelet therapy management.
Background:
The prognosis of patients with coronary artery disease (CAD) at hospital discharge was constantly varying, and postdischarge risk of ischemic events remain a concern. However, risk prediction tools to identify risk of ischemia for these patients has not yet been reported.
Aims:
We sought to develop a scoring system for predicting long-term ischemic events in CAD patients receiving antiplatelet therapy that would be beneficial in appropriate personalized decision-making for these patients.
Methods:
In this prospective Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD, NCT01735305) registry, a total of 14 032 patients with CAD receiving at least one kind of antiplatelet agent were enrolled from 107 centers across China, from January 2012 to March 2014. The risk scoring system was developed in a derivation cohort (enrolled initially 10 000 patients in the database) using a logistic regression model and was subsequently tested in a validation cohort (the last 4032 patients). Points in risk score were assigned based on the multivariable odds ratio of each factor. Ischemic events were defined as the composite of cardiac death, myocardial infarction or stroke.
Results:
Ischemic events occurred in 342 (3.4%) patients in the derivation cohort and 160 (4.0%) patients in the validation cohort during 1-year follow-up. The OPT-CAD score, ranging from 0-257 points, consist of 10 independent risk factors, including age (0-71 points), heart rates (0-36 points), hypertension (0-20 points), prior myocardial infarction (16 points), prior stroke (16 points), renal insufficient (21 points), anemia (19 points), low ejection fraction (22 points), positive cardiac troponin (23 points) and ST-segment deviation (13 points). In predicting 1-year ischemic events, the area under receiver operating characteristics curve were 0.73 and 0.72 in derivation and validation cohort, respectively. The incidences of ischemic events in low- (0-90 points), medium- (91-150 points) and high-risk (≥151 points) patients were 1.6%, 5.5%, and 15.0%, respectively. Compared to GRACE score, OPT-CAD score had a better discrimination in predicting ischemic events and all-cause mortality (ischemic events: 0.72 vs 0.65, all-cause mortality: 0.79 vs 0.72, both P < .001).
Conclusions:
Among CAD patients, a risk score based on 10 baseline clinical variables performed better than the GRACE risk score in predicting long-term ischemic events. However, further research is needed to assess the value of the OPT-CAD score in guiding the management of antiplatelet therapy for patients with CAD.
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