Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study

Aburadani, Isao; Usuda, Kazuo; Sumiya, Hisashi; Sakagami, Satoru; Kiyokawa, Hiroaki; Matsuo, Shinro; Takamura, Masayuki; Murai, Hisayoshi; Takashima, Shinya; Kitano, Teppei; Okuda, Koichi; Nakajima, Kénichi

doi:10.1016/j.jjcc.2017.12.006

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…As described above, ∆event risk did not correlate with ∆%Myo stress, but ∆event risk significantly correlated with ∆rest LVEF. Our findings concurred with the previous reports [14,15,17].…”

Section: Discussionsupporting

confidence: 94%

“…A larger sample and a longer follow-up might have resulted estimations of cardiac event risk that were comparable to real cardiac events. However, a previous evaluation of cardiac risk using the predictive value of the same J-ACCESS risk model used herein, confirmed essentially the same characteristics in 283 patients [15]. We concluded that a reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were both needed to reduce the likelihood of cardiac events.…”

Section: Discussionsupporting

confidence: 78%

“…However, cardiac events develop in 3% of patients with CAD at higher estimated cardiac risk even when stress MPS findings are normal [19]. Although several studies have concluded that %Myo stress is a clinical indicator [10,11], risk estimation by HRV, which integrates several risk factors, could be more useful than %Myo stress for predicting cardiac events [14,15], especially in patients with moderate-to-high risk.…”

Section: Discussionmentioning

confidence: 99%

“…Several risk factors that J-ACCESS associated with cardiac events [11] were included in risk estimation. The Heart Risk View-S software (HRV-S) calculated the probability of major cardiac events, including cardiac death, non-fatal myocardial infarction, and hospitalization due to severe heart failure, occurring over a period of 3 years, using the following equation based on a multi-variable logistic model [12][13][14][15]:…”

Section: Heart Risk Viewmentioning

confidence: 99%

“…Three-year cardiac event risk can be estimated based on the J-ACCESS risk model, which has been incorporated into Heart Risk View (HRV) software. This software calculates the probability (%) of major cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) arising during 3 years of follow-up [12][13][14][15]. The J-ACCESS4 study then clarified the prognostic impact of reducing myocardial ischemia among Japanese patients with stable CAD [6,16].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study

2021

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Background An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies. Methods This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year. Results Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively). Conclusions A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Heart Risk Viewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study

2021

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J-ACCESS investigation and nuclear cardiology in Japan: implications for heart failure

Nakajima

2023

Ann Nucl Med

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While coronary heart disease remains a global cause of mortality, the prevalence of heart failure (HF) is increasing in developed countries including Japan. The continuously increasing aging population and the relatively low incidence of ischemic origins are features of the HF background in Japan. Information about nuclear cardiology practice and prognosis has accumulated, thanks to the multicenter prognostic J-ACCESS investigations (Series 1‒4) over two decades in Japan. Although the rate of hard cardiac events is lower in Japan than in the USA and Europe, similar predictors have been identified as causes of major adverse cardiac events. The highest proportion (50–75%) of major events among patients indicated for nuclear cardiology examinations in the J-ACCESS registries is severe HF requiring hospitalization. Therefore, the background and the possible reasons for the higher proportion of severe HF events in Japan require clarification. Combinations of age, myocardial perfusion defects, left ventricular dysfunction, and comorbid diabetes and chronic kidney disease are major predictors of cardiovascular events including severe HF. Although the Japanese Circulation Society has updated its clinical guidelines to incorporate non-invasive imaging modalities for diagnosing chronic coronary artery disease, the importance of risk-based approaches to optimal medical therapy and coronary revascularization is emphasized herein.

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Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients with chronic kidney disease

Nakajima

Nakamura

Hase

et al. 2020

Journal of Nuclear Cardiology

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Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study

Abstract: The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice.

Cited by 7 publications

References 27 publications

Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study

Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study

J-ACCESS investigation and nuclear cardiology in Japan: implications for heart failure

Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients with chronic kidney disease

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