Abstract
BackgroundExisting cardiovascular risk scores for patients with established cardiovascular disease (CVD) estimate residual risk of recurrent major cardiovascular events (MACE). The aim of the current study is to develop and externally validate a prediction model to estimate the 10-year combined risk of recurrent MACE and cardiovascular interventions (MACE+) in patients with established CVD. MethodsData of patients with established CVD from the UCC-SMART cohort (N = 8421) were used for model development, and patient data from REACH Western Europe (N = 14,528) and REACH North America (N = 19,495) for model validation. Predictors were selected based on the existing SMART risk score. A Fine and Gray competing risk-adjusted 10-year risk model was developed for the combined outcome MACE+. The model was validated in all patients and in strata of coronary heart disease (CHD), cerebrovascular disease (CeVD), peripheral artery disease (PAD). ResultsExternal calibration for 2-year risk in REACH Western Europe and REACH North America was good, c-statistics were moderate: 0.60 and 0.58, respectively. In strata of CVD at baseline good external calibration was observed in patients with CHD and CeVD, however, poor calibration was seen in patients with PAD. C-statistics for patients with CHD were 0.60 and 0.57, for patients with CeVD 0.62 and 0.61, and for patients with PAD 0.53 and 0.54 in REACH Western Europe and REACH North America, respectively. ConclusionsThe 10-year combined risk of recurrent MACE and cardiovascular interventions can be estimated in patients with established CHD or CeVD. However, cardiovascular interventions in patients with PAD could not be predicted reliably.
Highlights
The number of patients in the chronic phase of cardiovascular disease (CVD) is growing as a result of improved survival after acute vascular events, an ageing populations, and deteriorating lifestyle habits such as sedentary behavior and unhealthy diet leading to obesity [1,2,3,4,5]
During a median follow-up time of 8.6 years (IQR 4.7–12.8) 2386 cardiovascular interventions occurred in the UCCSMART cohort, and recurrent major cardiovascular events (MACE) was observed in 1671 patients
In patients with established cardiovascular disease, cardiovascular interventions are more common than major cardiovascular events
Summary
The number of patients in the chronic phase of cardiovascular disease (CVD) is growing as a result of improved survival after acute vascular events, an ageing populations, and deteriorating lifestyle habits such as sedentary behavior and unhealthy diet leading to obesity [1,2,3,4,5]. The SMART risk score predicts the 10-year residual risk of recurrent major cardiovascular events (MACE), defined as non-fatal myocardial infarction, non-fatal stroke, or vascular death [16,17,18] Incidence rates of these events have steadily declined by in total 53% between 1996 and 2014 in a cohort of patients with stable cardiovascular disease [19]. Cardiovascular interventions such as amputations, peripheral revascularization procedures, cardiac interventions, and carotid endarterectomy cause significant morbidity [22,23], and from a patient's perspective might have a similar clinical impact as classical MACE For these reasons, calculating the risk of both cardiovascular events and cardiovascular interventions might provide a more accurate estimation of an individual's future health and risk, and provide a more appropriate translation from trial results to clinical practice, thereby aiding in determining preventive treatment strategies, informing patients, and facilitating shared decision making. Cardiovascular interventions in patients with PAD could not be predicted reliably
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