Risk of Cardiovascular Events Using the SMART Polyvascular Disease Risk Score.

Area of Science:

• Cardiology
• Preventive Medicine
• Health Informatics

Background:

• The Secondary Manifestations of Arterial Disease (SMART) risk score aids in projecting cardiovascular (CV) event risk.
• Risk stratification is crucial for developing effective mitigation strategies against CV disease.

Purpose of the Study:

• To analyze the utility of the SMART polyvascular disease score for calculating the risk of major adverse CV events (MACE) in a U.S. patient population.
• To validate the SMART risk score's predictive accuracy for MACE.

Main Methods:

• Utilized electronic health records from Baylor Scott & White (April 2014-October 2023) to identify patients undergoing their first cardiology evaluation.
• Estimated up to 10-year risk of MACE (all-cause death, ischemic stroke, nonfatal myocardial infarction).
• Employed Cox regression, accelerated failure time models, and survival analyses for score development and validation.

Main Results:

• The study included 259,250 patients, with a median follow-up of 2.1 years.
• The SMART risk score demonstrated accurate MACE prediction across risk strata (low, moderate, high, very high).
• Observed MACE rates in the test cohort were 2.9%, 15.0%, 24.5%, and 56.5% for increasing risk groups, outperforming the TRS2°P score (C-statistic = 0.811).

Conclusions:

• The SMART polyvascular disease risk score accurately estimates 10-year MACE risk.
• The score offers a valuable tool for developing individualized CV risk mitigation strategies.