Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients...

Area of Science:

• Nephrology
• Cardiology
• Prognostic Modeling

Background:

• Chronic kidney disease (CKD) poses significant cardiovascular risks.
• Accurate prediction of major cardiac events is crucial for managing CKD patients.
• Existing prognostic models require validation in diverse CKD cohorts.

Purpose of the Study:

• To validate the J-ACCESS risk models for major cardiac events in a new cohort of CKD patients.
• To assess the models' accuracy across different levels of kidney function.
• To determine the models' utility in guiding clinical risk stratification.

Main Methods:

• Validation of three multivariable J-ACCESS risk models (using age, stress score, ejection fraction, diabetes, and eGFR) in a 526-patient CKD cohort.
• Analysis of three-year major cardiac event rates (cardiac death, acute coronary syndrome, severe heart failure).
• Stratification of patients into low, intermediate, and high-risk groups based on model predictions and actual event rates.

Main Results:

• All three J-ACCESS models demonstrated good risk stratification for CKD patients with estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m².
• Patients with eGFR ≥15 showed distinct event rates across low (3.1%), intermediate (9.9%), and high (15.9%) risk groups (Model 2).
• CKD patients with eGFR <15 mL/min/1.73 m² exhibited similarly high event rates across all risk strata, irrespective of model-predicted risk.

Conclusions:

• The J-ACCESS risk models are effective for stratifying cardiovascular risk in CKD patients with eGFR ≥15.
• Patients with severe CKD (eGFR <15) may be at high risk for major cardiac events, necessitating vigilant monitoring.
• Further research is needed to refine risk prediction models for the most severe CKD population.