PROCAM Algorithm Research Articles

Medical information system for the rapid screening of cardiovascular risk in patients after coronary stenting

Aim. To develop and implement a decision support system for a software product – medical information system “1C: Medicine” in the form of calculator for assessment of the absolute risk of death from cardiovascular diseases (CVD) and to show the prospects of using this system for patients with coronary artery disease (CAD) after coronary stenting.Material and Methods. The medical information system “1C: Medicine” software interface was developed in Tyumen Cardiology Research Center. It was designed to assess 10-year absolute total mortality risk from CVD in males of working age (Tyumen Risk Scale (TRS)) to provide medical decision support. The program was tested in 764 male patients from the Prospective Registry of Percutaneous Coronary Interventions (PCI). The mean age of patients was 56.9 ± 8.8 years. All death cases, recorded within a year after PCI (n = 23), were used as the status check variable. The following algorithms were chosen to compare the predictive accuracy of the integrated model: PROCAM and FRAMINGHAM. The Schwarz information test and ROC analysis data were used to assess the predictive accuracy of the models.Results. The values of Schwarz’s criterion in males were 283 for TRS, 235 for PROCAM, and 490 for FRAMINGHAM model. AUC indicator for TRS was 0.655 (95% CI 0.510–0.800), suggesting the satisfactory quality of resulting model. AUC indicators for FRAMINGHAM and PROCAM algorithms were 0.599 (95% CI 0.442–0.757) and 0.653 (95% CI 0.509–0.796), respectively.Conclusion. The created TRS, integrated into the medical information system with psychosocial factors, may be quickly and successfully implemented to determine mortality risk in CAD patients within one year after coronary stenting. The TRS has an advantage over the traditional FRAMINGHAM risk scale and non-inferior to the PROCAM scale. Therefore, TRS may be used as a medical decision support program.

Welchen Risiko-Score verwenden – ESC-SCORE, Framingham-Score, PROCAM oder CARRISMA?

The assessment of overall cardiovascular risk can be performed with one of four different algorithms: the PROCAM algorithm, the ESC-SCORE (Systematic Coronary Risk Evaluation) or the Framingham risk score. The PROCAM-Score and the Framingham risk score emphasize more cholesterol-dependent events, the ESC-SCORE more blood pressure dependent events and CARRISMA utilizes the additional prognostic importance of life style factors on top of the three risk algorithms. Severe obesity (BMI > 35) as well as heavy smoking (40 cig/day) doubles the cardiovascular risk compared to a BMI of 25 or average smoking of 15 cig/day respectively. Regular physical activity can reduce the cardiovascular risk up to 40%. If the 10 year risk of myocardial infarction exceeds 20% or of cardiovascular letality 5% respectively an intensified prevention is cost effective and the Number Needed to Treat (NNT) is usually < 200.

Long-term cardiovascular risk in the orthotopic liver transplant population

In theoperative and peri-operative period, these events in-clude life-threatening arrhythmias at the time of donorliver reperfusion, myocardial ischemia or myocardialinfarction (MI) or congestive heart failure. In long termOLTx survivors, CV events include unstable angina, MIor death. Therefore, assessing short and long term CVrisk is an important aspect of the ESLD pretransplantevaluation.Currently, there is no widely accepted algorithm toidentify patients that are at high risk of perioperativetransplant CV events from the hemodynamic stress ofsurgery. Contrary to data in the vascular surgery pop-ulation

Analysis of coronary calcifications versus Framingham and PROCAM risk assessment in patients with a first myocardial infarction

We compared the extent of coronary calcifications as quantified by electron beam tomography (EBT) to the predicted 10-year cardiovascular event risk based on Framingham and PROCAM algorithms in patients with a first myocardial infarction (MI). Methods In 156 patients (56.7 ± 22 years), EBT was performed < 4 weeks after MI. Coronary calcifications were quantified using the “Agatston Score” and age-related calcium percentiles were determined. The predicted 10-year event risk was determined using Framingham and PROCAM algorithms. Results Coronary calcifications were present in 148 patients with a mean “Agatston Score” of 589.2 ± 976. The “Agatston Score” was > 400 in 44% and > 90th percentile in 42% of the patients. Framingham risk was > 20% in 32% and PROCAM risk was > 20% in 28%. Conclusion Coronary calcifications were detected in the vast majority of patients with a first MI, independent from the patient's age. The determination of age-related percentiles was superior to the Framingham or PROCAM algorithm.

High cardiovascular risk in young Saudi males: Cardiovascular risk factors, diet and inflammatory markers

Background The relationship between coronary risk score (CRS), individual coronary risk factors and the serum inflammatory markers, high sensitivity C-reactive protein (hsCRP), ceruloplasmin (Cp), and soluble intercellular adhesion molecule-1 (sICAM-1) was studied in 140 Saudi males without clinically evident coronary heart disease (CHD). Methods One hundred forty subjects without clinically evident CHD were categorized into age tertiles. Demographic data together with an estimate of CRS using Framingham and PROCAM algorithms were obtained, and serum lipid profile, glucose, hsCRP, sICAM-1, and Cp were measured. Macronutrient intake was assessed by a questionnaire. The relationship between CRS, biochemical markers and diet was assessed by univariate and multivariate analysis. Results There was no significant difference in median hsCRP, sICAM-1 or Cp between the age groups. Serum Cp was positively associated with age ( r = 0.224, p < 0.01) and FRS score ( r = 0.174, p < 0.05). Serum sICAM-1 was negatively associated with PROCAM score ( r = − 0.183, p < 0.05). sICAM-1 was positively associated with HDL cholesterol ( r = 0.36, p < 0.0001) among non-diabetics and negatively associated ( r = − 0.397, p < 0.05) among diabetic subjects. Age and dietary intake of saturated fatty acids together explained 7.9% of the variation in serum Cp level in a stepwise multiple regression model. Similarly 6.5% of the variation in serum sICAM-1 level was explained by the total cholesterol / HDL-C ratio. The youngest tertile of the group (< 30 y) had the highest dietary intake of energy, fat and saturated fatty acids ( p < 0.05), and also had a high prevalence of obesity, smoking and sedentary lifestyle. Conclusion We have demonstrated that there is a high prevalence of coronary risk factors and poor dietary intake within a Saudi male population, and that dietary factors are associated with serum sICAM-1 and ceruloplasmin but not hsCRP concentrations in this group.

Primärprävention der koronaren Herzerkrankung: Was ist in der Praxis bezahlbar?

In the primary prevention of coronary heart disease (CHD), the effect of aspirin and statins is well documented in several controlled randomized trials. For aspirin the results can be transferred into clinical practice due to its low price; for the more expensive statins, however, serious economic problems exist. In contrast to secondary prevention these drugs do not reach cost-efficiency in primary prevention; due to their high prices for the criteria of the randomized controlled studies values >60 000 or >100 000 [US dollars/YLS] are gained. Data from England and Scotland indicate that according to the inclusion criteria of the WOSCOPS- and AFCAPS/TexCAPS studies almost 20 and 60%, respectively, of the adult population had to be treated with a statin. Results of newer studies may even increase these numbers. These costs cannot be covered by any health care system. Primary prevention of CHD with statins reveals paradigmatically that for financial reasons evidence-based medicine can no longer be transferred into clinical practice. The limited resources of all health care systems make rationing with treatment allocation only to the high risk groups necessary. The American, European and German guidelines propose a > or =2% annual risk of CHD as the limit, for financial reasons the Britisch recommendations favor a limit of 3%; in order to save >50% of the costs. Despite the financial restraints of the German health care system, the limit of > or =2% annual risk of CHD as proposed by the German Cardiac Society may be realistic when the different preventive measures are applied following a step-by-step plan based on the costs. According to the Procam algorithms, persons without diabetes mellitus or familiar disposition, who in case of nicotine abuse have given up smoking and if hypertensive have blood pressure values within the therapeutic range, statins are only to be given under the following conditions: LDL-cholesterol > or =175 or > or =190 mg/dl, for a HDL-cholesterol < or =35 or < or =45 mg/dl, or triglyceride levels > or =200 or > or =175 mg/dl, respectively. Diabetics without CHD have the same risk as non-diabetics with CHD. Therefore, in diabetics the same measures should be taken for primary prevention as in non-diabetics for secondary prevention. Evaluation of cost-efficiency indicates that intensive blood sugar control as well as intensive antihypertensive treatment and application of statins are all cost-effective in primary prevention of diabetics.

A comparison of the PROCAM and Framingham point-scoring systems for estimation of individual risk of coronary heart disease in the Second Northwick Park Heart Study

We have compared the predictive value of the PROCAM and Framingham risk algorithms in healthy UK men from the Second Northwick Park Heart Study (NPHS-II) (50–64 years at entry), followed for a median of 10.8 years for coronary heart disease (CHD) events. For PROCAM, the area under the receiver operating characteristic (ROC) curve was 0.63 (95% CI, 0.59–0.67), and not significantly different ( p = 0.46) from the Framingham score, 0.62 (0.58–0.66). Sensitivities for a 5% false-positive rate (DR 5) were 13.8 and 12.4%, respectively. Calibration analysis for PROCAM gave a ratio of observed to expected events of 0.46 (Hosmer–Lemeshow test, p < 0.0001) and 0.47 for Framingham ( p < 0.0001). Using measures taken at 5 years of high-density lipoprotein cholesterol and (estimated) low-density lipoprotein cholesterol levels increased the ROC by only 1%. An NPHS-II risk algorithm, developed using a 50% random subset, and including age, triglyceride, total cholesterol, smoking status, and systolic blood pressure at recruitment, gave an ROC of 0.64 (0.58–0.70) with a DR 5 of 10.7% when applied to the second half of the data. Adding family history and diabetes increased the DR 5 to 18.4% ( p = 0.28). Adding lipoprotein(a) >26.3 mg/dL (relative risk 1.6, 1.1–2.4) gave a DR 5 of 15.5% ( p = 0.55), while adding fibrinogen levels (relative risk for 1S.D. increase = 1.5, 1.1–2.0) had essentially no additional impact (DR 5 = 16.9%, p = 0.95). Thus, the PROCAM algorithm is marginally better as a risk predictor in UK men than the Framingham score, but both significantly overestimate risk in UK men. The algorithm based on NPHS-II data performs similarly to those for PROCAM and Framingham with respect to discrimination, but gave an improved ratio of observed to expected events of 0.80 ( p = 0.01), although no score had a high sensitivity. Any novel factors added to these algorithms will need to have a major impact on risk to increase sensitivity above that given by classical risk factors.

W01.74 Ten year cardiovascular risk assessment in practice-based subjects: A comparison between a modified PROCAM algorithm (PROCm), the European guides (EU03) and atherosclerosis imaging

W01.74 Ten year cardiovascular risk assessment in practice-based subjects: A comparison between a modified PROCAM algorithm (PROCm), the European guides (EU03) and atherosclerosis imaging

W01.74 Ten year cardiovascular risk assessment in practice-based subjects: A comparison between a modified PROCAM algorithm (PROCm), the European guides (EU03) and atherosclerosis imaging

W01.74 Ten year cardiovascular risk assessment in practice-based subjects: A comparison between a modified PROCAM algorithm (PROCm), the European guides (EU03) and atherosclerosis imaging

Relation between coronary calcium and 10-year risk scores in primary prevention patients

In 380 patients, coronary calcifications were quantified by electron beam tomography and compared with the predicted 10-year cardiovascular event risk determined by the Framingham equation, Adult Treatment Panel III tables, and the PROCAM algorithm. The correlation between the amount of calcium and the predicted cardiac event risk was low (correlation coefficient range 0.19 to 0.28). The assessment of coronary calcium may thus potentially yield information that is additive to the analysis of traditional risk factors.