Pre-existing Risk Factors Research Articles

Posterior Reversible Encephalopathy Syndrome in a Child with Sickle Cell Disease and SARS-CoV-2 Infection

AbstractThe full range of neurological manifestations of novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection in children remains incompletely characterized. Here, we discussed a 7-year-old male child patient with sickle cell disease (SCD), who presented with acute encephalopathy and nonconvulsive (electrographic only) seizures immediately prior to the onset of severe symptomatic SARS-CoV-2 infection, manifesting as respiratory failure, systemic inflammatory response, and hypertension. Brain imaging confirmed hyperintense lesions consistent with posterior reversible encephalopathy syndrome (PRES). Following aggressive symptomatic management including antiseizure medication, immunomodulatory treatment of SARS-CoV-2 infection, and intensive blood pressure control, he made a full neurological recovery. PRES has been observed in adults with SARS-CoV-2 infection, but there are few published reports of this neurological manifestation in children. Our case demonstrates that PRES should be a consideration in children with SARS-CoV-2 infection presenting with acute neurological decompensation, especially in the setting of preexisting risk factors for cerebrovascular dysregulation such as SCD.

Determinants of Atrial Fibrillation Development among Patients undergoing Ibrutinib Therapy.

Objective: Within the last decade, the use of ibrutinib, a first-generation, non-selective, irreversible Burton's tyrosine kinase inhibitor for the treatment of hematological malignancies has proven highly effective in improving patient outcomes.Background: Ibrutinib has been associated with an increase in atrial fibrillation (AF). The predisposing factors are thought to be pre-existing cardiovascular risk factors, but these have not been directly evaluated.Methods: We conducted a nested case-control study, recruiting consecutive ibrutinib treated subjects to evaluate cardiovascular risk factors associated with the development of AF in patients diagnosed with hematological B-cell malignancies.Results: Of the 189 patients treated with ibrutinib and without AF at baseline, 54 (29%) developed AF. Cardiovascular risk factors associated with AF development were, older age, prior hypertension (HTN), history of heart failure (HF) and congenital heart disease. A patient with HF at baseline had a 1, 2, 6, and 12 month cumulative hazard of AF of 40%, 48%, 64%, and 71%, respectively. Patients with prior HTN without HF at baseline had a 1, 2, 6, and 12 month cumulative hazard of AF of 5%, 10%, 23%, and 31%, respectively while on ibrutinib therapy.Conclusions: The relationship between ibrutinib, cardiovascular comorbidities, and AF is through pre-existing cardiovascular disease. An individualized, multidisciplinary approach involving cardiologists should be considered when initiating ibrutinib, particularly when there is a history of HTN, HF or congenital heart disease. In such patients, there should be close cardiovascular monitoring and prompt intervention when AF develops to improve patient outcomes.

Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study.

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p < 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p < 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p < 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p < 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p < 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p < 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p < 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Caregiving for People With Dementia or Cognitive Impairment During the COVID-19 Pandemic: A Review.

The COVID-19 pandemic has been a major source of stress for informal caregivers for people with dementia. Studies show the unique challenges caregivers face, such as social isolation, extended work hours, and adherence to public health guidelines. We conducted a narrative review of factors impacting well-being of informal caregivers of older adults with dementia during the COVID-19 pandemic. Sixty-four papers were identified as published between June 2020 and December 2021. All studies were conducted in the U.S. or other Western countries and were cross-sectional and conducted prior to COVID-19 vaccines. Articles highlighted increasing burdens such as financial and physical stress, as well as worsened psychological well-being from anxiety and depression. Protective factors such as social support and telehealth interventions also emerged. Limitations include lack of longitudinal information to identify broader themes on caregiving during the pandemic. Studies not only identified new, pandemic-related risk factors, but also a heightened effect of pre-existing risk factors (e.g., income, living situation) on caregiver burden.

Cardiovascular risk factors of poor prognosis in COVID-19 – a review

Since the first report in 2019, COVID-19 has claimed many lives, even those previously in good health. Therefore, a proper diagnosis and identification of patients at the highest risk of serious complications is vital. In fact, COVID-19 can lead to systemic inflammation and multiorgan dysfunction. Apart from the respiratory system, the circulatory system is also affected, including numerous complications due to the cytokine storm, direct cytotoxic effects, downregulation of angiotensin-converting enzyme 2, and low oxygen blood levels. In this review, we discussed cardiovascular risk factors associated with a poor prognosis in COVID-19 patients, including pre-existing risk factors or those acquired in the course of the infection. We also analyzed the role of biomarkers, ECG, and imaging in the identification of patients at the highest risk of unfavorable outcomes, as even subtle abnormalities in additional tests may have a significant impact on disease management.

Epidemiological profile of postoperative digestive fistulas

Background and objectives: Gastrointestinal fistulas are anomalous communications between the digestive system and other structures. This article presents the epidemiological profile of patients who developed postoperative abdominal fistulas and their outcomes. Methods: Cross-sectional study that evaluated surgical procedures done in a 25 week period that presented risks for fistulous formations. Were analyzed age, type of the surgery (elective or urgent), pre-existing risk factors, need for post-surgical intensive care unit, type of fistula, reoperations to the fistula treatment, and outcome (discharge or death). Results: There were 1785 abdominal surgical procedures, with a fistula incidence of 1.8%. Most of the patients who developed fistulas were over 60 years old (71.4%), and surgeries that resulted in fistulous complications were mainly urgent (75.0%), with the need for intensive care in 46.9%. The most frequent types of fistula were enteral (52.3%) and biliary (23.8%), and surgical treatment took place in 53.1% of cases. Late hospital discharge was predominant in these patients (40.6%), and the death rate was 3.1%. Discussion: These complications are common after abdominal surgery and require clinical attention. There is a correlation between the formation of the fistulas and urgent surgery procedures, directly impacting the length of hospital stay. Conclusion: The risk factors of fistula development are advanced age and the presence of malignant disease. They are more prevalent in urgent surgeries and patients were more likely to need reoperation and have a delay on discharge.

Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Scuba diving-related fatalities in New Zealand, 2007 to 2016.

New Zealand (NZ) diving-related fatalities have been reported since the 1960s. The aim is to identify contributing risk factors, including medical, and to inform appropriate preventative strategies. NZ scuba diving fatalities from 2007 to 2016 were searched from multiple sources - the National Coronial Information System (NCIS); the NZ Chief Coroner's office; Water Safety NZ Drownbase™ and the NZ Police National Dive Squad records. For inclusion, a victim must have been wearing a scuba set (which may include a rebreather). A key word search of the NCIS was made and the results matched to the other databases. An Excel® database was created and a chain of events analysis (CEA) conducted. Forty-eight scuba diving fatalities were identified, 40 men and eight women, average age 47 years (range 17-68), 20 of Māori ethnicity. Thirty-five were classified as overweight (14) or obese (21). Pre-existing medical risk factors were identified, either pre dive or at autopsy, in 37 divers, the commonest being ischaemic heart disease (IHD, 20), left ventricular hypertrophy (LVH, 18) and hypertension (seven). IHD, LVH and obesity were variously associated with each other. The likely commonest disabling conditions, identified in 32 cases, were asphyxia (15), cardiac (nine) and pulmonary barotrauma/cerebral arterial gas embolism (five). Multiple environmental and diving practice breaches and poor planning were identified in the CEA, similar to those seen in other studies. Thirty-eight divers had not released their weight belt. Information on resuscitation was limited. Obesity and cardiovascular disease were common and Māori appear to be over-represented, both as previously reported.

Urinary liver-type fatty acid-binding protein as a prognostic marker in patients with acute heart failure.

AimsUrinary liver‐type fatty acid‐binding protein (L‐FABP) is expressed in proximal tubular epithelial cells and excreted into the urine during tubular injury. We hypothesized that high urinary L‐FABP is associated with poor prognosis in patients with acute heart failure (AHF).Methods and resultsWe analysed 623 patients (74 ± 13 years old; 60.0% male patients) with AHF. Urinary L‐FABP levels were measured at the time of admission and adjusted for the urinary creatinine concentration. The primary endpoint was all‐cause mortality. The median value and interquartile range of urinary L‐FABP levels were 6.66 and 3.37–21.1 μg/gCr, respectively. Urinary L‐FABP levels were significantly correlated with both beta‐2 microglobulin and cystatin C levels; the correlation with the former was higher than that with the latter. During the follow‐up of 631 (interquartile range: 387–875) days, 142 deaths occurred. A high tertile of urinary L‐FABP level was associated with high mortality; this association was retained after adjusting for other covariates (second tertile hazard ratio 1.40, P = 0.152 vs. first tertile; third tertile hazard ratio 1.94, P = 0.005 vs. first tertile).ConclusionsUrinary L‐FABP is more closely associated with tubular dysfunction than with glomerular dysfunction. Tubular dysfunction, which was evaluated based on urinary L‐FABP levels, in patients with AHF is associated with all‐cause mortality and is independent of pre‐existing risk factors. L‐FABP should be considered for use in the prognosis of AHF.

Mucormycosis in Post COVID-19 Patients: A Case Study

Introduction: Acute respiratory distress syndrome (ARDS) is a common complication of severe pneumonia virus, such as the flu and COVID-19, which requires critical treatment, including asthma support, corticosteroids, and other treatments to prevent acute respiratory tract inflammation. Although steroid treatment is limited to the treatment of viral pneumonia, it is usually a double-edged sword, leading to increased morbidity and mortality. Mucormycosis is a fungal emergency with a high tendency for contaguous spread and a poor prognosis if not detected and treated promptly. Mucormycosis is believed to be caused by uncontrolled diabetes mellitus (DM) and other immunosuppressive disorders, such as corticosteroid therapy.&#x0D; Aim: To discuss causality factor of mucormycosis in COVID-19 infection.&#x0D; Conclusion: COVID-19 is correlated with a high rate of secondary infections, both bacterial and fungal, most likely as a result of immune dysregulation. Furthermore, the widespread use of steroids and broad-spectrum antibiotics as part of the COVID-19 remedy can result in the production or exacerbation of pre-existing fungal diseases. Physicians should be mindful of the likelihood of invasive secondary fungal infections in patients with COVID-19 infection, especially in those that have pre-existing risk factors, and should be able to detect and treat these infections early in order to reducing mortality and morbidity.

Cause or Consequence? What is the Relationship between Cardiac Injury and COVID-19 Severity?

In most patients, coronavirus disease-2019 (COVID-19) causes minor respiratory symptoms or even no symptoms. SARS-CoV-2 infection can also cause extrapulmonary manifestations and complications. COVID-19 is more severe and fatal among patients with pre-existing cardiovascular risk factors or diseases. Increases in cardiac troponin (cTn) are indicative of myocardial injury and frequently found in patients with COVID-19. The Chinese Center for Disease Control and Prevention published a survey demonstrating that among patients diagnosed with COVID-19, 13% had hypertension, 5% had diabetes mellitus, [...]

Reproductive history and blood cell DNA methylation later in life: the Young Finns Study

BackgroundWomen with a history of complications of pregnancy, including hypertensive disorders, gestational diabetes or an infant fetal growth restriction or preterm birth, are at higher risk for cardiovascular disease later in life. We aimed to examine differences in maternal DNA methylation following pregnancy complications.MethodsData on women participating in the Young Finns study (n = 836) were linked to the national birth registry. DNA methylation in whole blood was assessed using the Infinium Methylation EPIC BeadChip. Epigenome-wide analysis was conducted on differential CpG methylation at 850 K sites. Reproductive history was also modeled as a predictor of four epigenetic age indices.ResultsFourteen significant differentially methylated sites were found associated with both history of pre-eclampsia and overall hypertensive disorders of pregnancy. No associations were found between reproductive history and any epigenetic age acceleration measure.ConclusionsDifferences in epigenetic methylation profiles could represent pre-existing risk factors, or changes that occurred as a result of experiencing these complications.

Outcome of four-point fixated open loop polymethyl methacrylate anterior chamber intraocular lens.

To study long-term visual and refractive outcomes and complications in eyes with anterior chamber intraocular lens (ACIOL) implantation. Data of patients who underwent primary and secondary ACIOL implantation at L V Prasad Eye Institute, Bhubaneswar between 2011 and 2020 was collected, including details of post-operative visits. For analysis, sample was divided into: group Ia (primary ACIOL in cases without risk factors, n = 104); group Ib (primary ACIOL in cases with pre-existing risk factors, n = 49); and group II (secondary ACIOL, n = 40). A total of 193 eyes of 192 patients were included. Mean post-operative follow-up in groups I and II were 8.6 and 11.51months, respectively. Mean pre-operative and last visit corrected distance visual acuity were 1.73 ± 0.11 and 0.42 ± 0.05 logMAR units in group Ia (p < 0.001), and 1.53 ± 0.14 and 0.49 ± 0.10 logMAR units in group Ib (p < 0.001). The mean spherical equivalent (MSE) for last refraction was -0.37 ± 0.18 diopters (D) and -0.15 ± 0.51 D in groups I and II, respectively. Of 76 eyes in which addition of 2.5 D (over the near emmetropic posterior chamber intraocular lens power) was taken for ACIOL, 40 (52.6%) had MSE within ± 0.5 D. Most common complications were transient corneal edema and anterior chamber reaction. Eyes on anti-glaucoma medications at last visit were eight (7.7%), 15 (30.6%), and two (5.0%) in groups Ia, Ib, and II, respectively. We observed that ACIOLs have good visual and refractive outcomes. Raised IOP is a concern in eyes with pseudoexfoliation, but can be managed with close monitoring. Hence ACIOL can be a good option for managing aphakia after cataract surgery.

Epigenetic Approach to PTSD: In the Aspects of Rat Models.

Posttraumatic stress disorder (PTSD) is a stress-related mental disorder and develops after exposure to life-threatening traumatic experiences. The risk factors of PTSD included genetic factors; alterations in hypothalamic–pituitary–adrenal (HPA) axis; neurotrophic, serotonergic, dopaminergic, and catecholaminergic systems; and a variety of environmental factors, such as war, accident, natural disaster, pandemic, physical, or sexual abuse, that cause stress or trauma in individuals. To be able to understand the molecular background of PTSD, rodent animal models are widely used by researchers. When looking for a solution for PTSD, it is important to consider preexisting genetic risk factors and physiological, molecular, and biochemical processes caused by trauma that may cause susceptibility to this disorder. In studies, it is reported that epigenetic mechanisms play important roles in the biological response affected by environmental factors, as well as the task of programming cell identity. In this article, we provided an overview of the role of epigenetic modifications in understanding the biology of PTSD. We also summarized the data from animal studies and their importance during the investigation of PTSD. This study shed light on the epigenetic background of stress and PTSD.

Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer.

PurposeThis study compares photon and proton therapy plans for patients with synchronous bilateral early breast cancer and estimates risks of early and late radiation-induced toxicities.Materials and MethodsTwenty-four patients with synchronous bilateral early breast cancer receiving adjuvant radiation therapy using photons, 3-dimensional conformal radiation therapy or volumetric modulated arc therapy, were included and competing pencil beam scanning proton therapy plans were created. Risks of dermatitis, pneumonitis, acute esophageal toxicity, lung and breast fibrosis, hypothyroidism, secondary lung and esophageal cancer and coronary artery events were estimated using published dose-response relationships and normal tissue complication probability (NTCP) models.ResultsThe primary clinical target volume V95% and/or nodal clinical target volume V90% were less than 95% in 17 photon therapy plans and none of the proton plans. Median NTCP of radiation dermatitis ≥ grade 2 was 18.3% (range, 5.4-41.7) with photon therapy and 58.4% (range, 31.4-69.7) with proton therapy. Median excess absolute risk (EAR) of secondary lung cancer at age 80 for current and former smokers was 4.8% (range, 0.0-17.0) using photons and 2.7% (range, 0.0-13.6) using protons. Median EAR of coronary event at age 80, assuming all patients have preexisting cardiac risk factors, was 1.0% (range, 0.0-5.6) with photons and 0.2% (range, 0.0-1.3) with protons.ConclusionProton therapy plans improved target coverage and reduced risk of coronary artery event and secondary lung cancer while increasing the risk of radiation dermatitis.

Deep Venous Thrombosis And Pulmonary Thromboembolism In A Physically Nonprepared Trekker In The Himalayas – An Autopsy Report.

Deep venous thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Having said that, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, he may end up with fatal thromboembolic events. Here we report a case of a low lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

An innovative 'Prop technique' of mouth opening in post-COVID-19 mucormycosis maxillectomy: Finding a new way with minimal efforts.

General anaesthesia is associated with damage to teeth, particularly during laryngoscopy. Dental injury is more probable when pre-existing dental pathology or risk factors are present. Post-coronavirus disease -2019 mucormycosis is a rare, fulminant, lethal, angio-invasive, opportunistic fungal disease and is increasingly recognised in diabetic and immunocompromised patients. Since the flange of the laryngoscope blade appears to be the source of tooth injury, alternate methods of wide mouth opening during laryngoscopy should be examined, especially when mouth opening is limited. In this case series, we have studied 12 cases of maxillectomies with an aim to improve restricted mouth opening by using the 'Prop technique' resulting in a minimum hinging force of the flange of the blade on teeth. Preoperatively, patients were warned about the possibility of dental injuries during anaesthesia or surgery.

Coronary artery calcifications on breast cancer radiotherapy planning CT scans and cardiovascular risk: What do patients want to know?

BackgroundCoronary artery calcifications (CAC) is a strong predictor of cardiovascular disease (CVD), which can be automatically quantified on routine breast radiotherapy planning computed tomography (CT) scans. Around 8% of patients have (very) high CAC scores and corresponding increased risks of CVD. AimThis study explores whether, how, and under what conditions women with breast cancer want to be informed about their CAC-based CVD risk. MethodsA cross-sectional survey study was conducted in a random sample of UMBRELLA, a prospective breast cancer cohort. Participants (n = 79) filled out a questionnaire about their knowledge on the CVD risk following breast cancer, their interest in being informed about their CVD risk based on CAC score, and preferences on how they would want to receive this information. ResultsMost participants (66%) were not aware that the presence of CAC indicates an increased CVD risk. Participants indicated that they were not or only slightly aware of the risk of treatment-induced cardiotoxicity (48%), and that the risk of cardiotoxicity was higher in patients with pre-existing CVD risk factors (82%). The vast majority (90%) indicated that they want to be informed about in increased CAC-based CVD risk. ConclusionsThe majority of patients with breast cancer wants to be informed about their CAC-based CVD risk. With the majority of patients with breast cancer undergoing radiotherapy, and with low cost and automated options for accurate CAC measurement in planning CT scans, it is important to develop strategies to manage patients with an increased CAC-based risk of CVD.

Repeated or Continuous Medically Supervised Ketamine Administration Associated with Hepatobiliary Adverse Events: ARetrospective Case Series.

IntroductionEmerging off-label medical uses of ketamine for the treatment of persistent conditions such as depression and chronic pain often require repeated administration. Cases reported by other countries suggest that long-term and repeated exposure to ketamine may be associated with several risks, including but not limited to hepatobiliary damage.ObjectiveWe aimed (1) to characterize the association between repeated administration of ketamine for off-label medical use and hepatobiliary events and (2) to describe recent trends in the use of ketamine across different clinical settings.MethodsWe conducted a retrospective case series analysis, utilizing reports identified from the US Food and Drug Administration Adverse Event Reporting System database as well as the medical literature. We included all cases reported through July 2018 describing both repeated exposure to ketamine in a hospital or ambulatory setting and a hepatobiliary adverse event. We excluded cases describing ketamine abuse. We identified adverse hepatobiliary events using the Medical Dictionary for Regulatory Activities (MedDRA®) and summarized various case characteristics including: patient demographics, route of ketamine administration, dose, time to onset of event, type of event, and pre-existing risk factors for hepatobiliary disease. To assess trends in the demand for ketamine, we used IQVIA, National Sales Perspectives™ to provide the nationally estimated number of vials sold for ketamine from the manufacturer to all US channels of distribution from 2013 through 2017.ResultsWe identified 14 unique cases that met selection criteria with 21 hepatobiliary adverse events including liver enzyme elevation in all cases, biliary dilation with liver cirrhosis (n = 1), biliary dilation with cholangitis (n = 1), and pericholeductal fibrosis (n = 1). Most cases received ketamine for the treatment of complex regional pain syndrome or chronic pain. In cases with a reported time to onset, the majority of events occurred within 4 days. The nationally estimated number of ketamine vials sold in the USA from manufacturers to various channels of distribution increased from 1.2 million in 2013 to 2.1 million in 2017.ConclusionsWe report an association between repeated or continuous administration of ketamine and hepatobiliary adverse events. Increased awareness among clinicians may mitigate these adverse outcomes, especially in the context of growing ketamine sales.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01120-9.

Cardiac Radiation Dose and Patient Risk Factors for Predicting Major Adverse Cardiac Events in Lung Cancer Patients

<h3>Purpose/Objective(s)</h3> Thoracic radiotherapy (TRT) is a mainstay treatment for locally advanced non-small cell lung cancer (LA-NSCLC). Mean heart dose (MHD) and left anterior descending (LAD) receiving ≥15 Gy (LADV15) was shown to predict major adverse cardiac events (MACE) in LA-NSCLC patients receiving TRT. We aim to develop a clinically applicable MACE risk prediction score model, including both cardiac dosimetric and baseline risk factors. <h3>Materials/Methods</h3> Retrospective data from 748 consecutive patients with LA-NSCLC treated with curative intent between November 1998 to December 2013 were included. The data was split based on diagnosis dates to allow external validation. Model development was performed on 500 consecutive patients diagnosed before December 2010 using multivariable Cox-proportional hazard model; backward elimination scheme (α = 0.05) was used to select the predictors for the final model. Potential predictors were selected <b>a priori</b> based on prior literature: age, pre-existing coronary heart disease (CHD), Framingham Risk, hypertension (HTN), MHD, LADV15, intensity modulated RT (IMRT) use, and interaction between CHD and LADV15 (CHD:LADV15). Model performance was assessed by the Harrell's c-index and internally validated using leave-one out cross validation (LOOCV). The model was applied to the remaining 248 consecutive patients from the initial cohort as the external validation "test" dataset. <h3>Results</h3> The development and test cohorts had median age 64 vs 66 years (<i>P</i> = 0.02), 51.0 vs. 50.4% females (<i>P</i> = 0.88), and 89.4 vs 89.1% stage III cancer (<i>P</i> = 0.91). The final model incorporated CHD, HTN, LADV15, and CHD:LADV15 (β coefficients: 2.703, 1.129, 0.043, -0.047; all <i>P</i> < 0.001; c-index 0.773). LOOCV Pseudo R² = 0.0195. The c-index on the external test dataset was 0.727. Actuarial 3-year MACE rates were 10.7% for development cohort and 15.4% for test cohort. Stratifying development cohort patients into terciles based on MACE risk prediction scores yielded 3-year MACE rates of 0%, 5.7%, and 25.6% for lowest to highest risk-terciles, respectively; among test cohort, the 3-year MACE rates were 4.9%, 10.5%, and 31.9%. Respectively, the 3-year overall survival rates for lowest to highest MACE risk-terciles were 47.3%, 35.2%, and 32.8% among development cohort, and 52.3%, 43.9% and 30.6% within test cohort (both Log-rank <i>P</i> < 0.05). <h3>Conclusion</h3> The 3-year MACE rates spans 5% to 32% from lowest to highest risk groups. Both LADV15 and pre-existing cardiac risk factors are important in predicting MACE risk post-TRT. MACE risk score was associated with survival. This tool has the potential to estimate personalized LADV15 constraints based on patient risk factors and acceptable MACE risk thresholds (e.g., 5-10%), thus may help identify patients who may benefit most from the application of advanced RT techniques to further reduce LAD dose as a modifiable risk factor during RT planning.