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Risk of Cardiovascular Events Using the SMART Polyvascular Disease Risk Score
Subhash Banerjee1, Anand Gupta2, Minseob Jeong2
1Division of Cardiology, Baylor Scott & White Heart and The Heart Hospital at Dallas, Dallas, Texas, USA; Baylor University Medical Center, Dallas, Texas, USA; Veterans Affairs North Texas Healthcare System, Dallas, Texas, USA.
Insights
The Secondary Manifestations of Arterial Disease (SMART) polyvascular disease score accurately predicts major adverse cardiovascular (CV) events up to 10 years. This score can guide personalized strategies to reduce CV risk.
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.
Background:
Secondary Manifestations of Arterial Disease (SMART) risk score-based projection of risk for cardiovascular (CV) events can help devise risk mitigation strategies.
Objectives:
The objective of the study was to analyze the use of the SMART polyvascular disease score to compute the risk for major adverse CV events (MACE) in U.S.
Methods:
We accessed the Baylor Scott & White EPIC informatics and data warehouse to identify patients at their first outpatient cardiology evaluation between April 2014 and October 2023 to estimate up to 10-year risk of MACE, a composite of all-cause death, ischemic stroke, and nonfatal myocardial infarction (MI). Cox regression, accelerated failure time model, and survival analyses were used to develop and validate the SMART risk score.
Results:
The study population of 259,250 patients (mean age 60.9 ± 15.2 years, 48.6% females) were divided into development (60%) and test (40%) cohorts; median follow-up 2.1 years (IQR: 0.54-4.4). The SMART risk score allowed accurate estimation of MACE. Patients in low (<10%), moderate (10%-<20%), high (20%-<30%), and very high (≥30%) SMART risk score groups had observed MACE events rates of 2.9%, 15.0%, 24.5%, and 56.5%, respectively, in the test cohort (P < 0.0001 for all intergroup comparisons). Most MACE events were all-cause death, with nonfatal myocardial infarction and stroke also being high, in the very high-risk group. The SMART score outperformed an established risk prediction model (TIMI Risk Score for Secondary Prevention [TRS2°P]; C-statistic = 0.811) in the test cohort.
Conclusions:
The SMART polyvascular disease risk score can provide accurate estimation of up to 10-year risk of CV events and could be potentially leveraged to develop individualized risk mitigation strategies.
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