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Published on: August 9, 2024
Simple Laboratory Test-Based Risk Scores in Coronary Catheterization: Development, Validation, and Comparison to
Michael E Gerling1, Yuan Dong2, Beelal Abdalla3
1Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada.
Insights
New laboratory test-based risk scores accurately predict mortality risk in patients undergoing their first coronary catheterization, offering a powerful alternative to traditional risk factors.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biostatistics
Background:
- Coronary catheterization is a common procedure with associated mortality risks.
- Accurate risk stratification is crucial for patient management and decision-making.
- Existing risk scores may not fully capture mortality risk in all patient populations.
Purpose of the Study:
- To develop and validate laboratory test-based risk scores (lab risk scores) for reclassifying mortality risk in patients undergoing their first coronary catheterization.
- To compare the predictive performance of lab risk scores against conventional demographic and clinical risk factors.
Main Methods:
- Utilized logistic regression with group LASSO penalty to select significant laboratory tests (<30 days pre-catheterization) and demographic factors associated with mortality.
- Developed risk scores from selected variables and validated them internally (Calgary) and externally (Edmonton).
- Assessed discrimination, calibration, and net reclassification improvement compared to traditional risk factors.
Main Results:
- Lab risk scores demonstrated strong associations with mortality (29-40x higher risk for top vs. bottom quintile).
- Scores showed good discrimination and calibration in both derivation and validation cohorts (C-indices 0.80-0.85).
- Lab risk scores reclassified 11%-20% of deaths and 6%-9% of survivors, outperforming traditional risk factors.
Conclusions:
- Laboratory test-based risk scores are as powerful as demographic and clinical factors in predicting mortality after coronary catheterization.
- These lab risk scores offer a valuable tool for risk stratification in patients undergoing the procedure.
- Implementation of lab risk scores can improve patient management and outcomes.
Background:
We developed and validated laboratory test-based risk scores (i.e., lab risk scores) to reclassify mortality risk among patients undergoing their first coronary catheterization.
Methods:
Patients were catheterized between 2009 and 2015 in Calgary, Alberta, Canada (n = 14 135, derivation cohort), and in Edmonton, Alberta, Canada (n = 12 143, validation cohort). Logistic regression with group LASSO (least absolute shrinkage and selection operator) penalty was used to select quintiles of the last laboratory tests (red blood cell count, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red cell distribution width, platelet count, total white blood cell count, plasma sodium, potassium, chloride, CO2, international normalized ratio, estimated glomerular filtration rate) performed <30 days before catheterization and by age and sex that were significantly associated with death ≤60 and >60 days after catheterization. Follow-up was until 2016. Risk scores were developed from significant tests, internally validated in Calgary among bootstrap samples and externally validated in Edmonton after recalibration using coefficients developed in Calgary. Interaction tests were performed, and net reclassification improvement vs conventional demographic and clinical risk factors was determined.
Results:
Lab risk scores were strongly associated with mortality (29-40× for top vs bottom quintile, P for trends <0.01), had good discrimination and were well calibrated in Calgary (C = 0.80-0.85, slope = 0.99-1.01) and Edmonton (C = 0.80-0.82; slope = 1.02-1.05)-similar to demographic and clinical risk factors alone. Associations were attenuated by several comorbidities; however, scores appropriately reclassified 11%-20% of deaths (both follow-up periods) and 6%-9% of survivors (>60 days) after catheterization vs demographic and clinical risk factors.
Conclusions:
In 2 populations of patients undergoing their first coronary catheterization, risk scores based on simple laboratory tests were as powerful as a combination of demographic and clinical risk factors in predicting mortality. Lab risk scores should be used for patients undergoing coronary catheterization.
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