Prognostic table for predicting major cardiac events based on J-ACCESS investigation

Abstract

Objectives. The event risk of patients with coronary heart disease may be estimated by a large-scale prognostic database in a Japanese population. The aim of this study was to create a Heart Risk Table for predicting the major cardiac event rate. Methods. Using the J-ACCESS database created by a prognostic investigation involving 117 hospitals and >4000 patients in Japan, multivariate logistic regression analysis was performed. The major event rate over a 3-year period that included cardiac death, non-fatal myocardial infarction and severe heart failure requiring hospitalization was predicted by the logistic regression equation. The algorithm for calculating the event rate was simplified for creating tables. Results. Two tables were created to calculate cardiac risk by age, perfusion score category and ejection fraction with and without a presence of diabetes. A relative risk table comparing age-matched control subjects was also made. When the simplified tables were compared with the results from original logistic regression analysis, both risk values and relative risks agreed well (p<0.0001 for both). Conclusion. The Heart Risk Table was created for patients suspected of having ischemic heart disease and who underwent myocardial perfusion gated single-photon emission computed tomography. The validity of risk assessment using a J-ACCESS database should be validated in a future study.

Cardiac Event Risk in Japanese Subjects Estimated Using Gated Myocardial Perfusion Imaging, in Conjunction With Diabetes Mellitus and Chronic Kidney Disease

“…11 Although the initial and revised versions of the Heart Risk Table depended on analyses of 4,031 subjects (variable of DM only) and on 2,432 subjects (variables of DM and CKD), respectively, reasonable consistency of event risks was confirmed. To create risk tables, we used each 10%-increment class in EF and 10-year class in age in both versions.…”

“…The consistency between the previous version of risk calculation 11 and this new version including both DM and CKD was investigated.…”

“…4, 11 Briefly, a total of 4,031 patients were analyzed after excluding early revascularization within 60 days of single-photon emission computed tomography (SPECT). According to the inclusion criteria, subjects aged ≥20 years who underwent stress-and-rest electrocardiography (ECG)-gated SPECT because of suspected or known ischemic heart disease, were enrolled.…”

“…Based on the J-ACCESS investigation summary (n=4,031), the major event rate was estimated using the following equation: 11 Major event risk (%/3 years) = 1/(1 + Exp[-(-4.8125 + 0.8858…”

“…11 The risk tables would be fitted to clinical practice in Japan and would be suitable for those patients thought to have CAD and who undergo MPI. A US study used prognostic scores to estimate event risks based on a stress myocardial perfusion, but the authors did not use a risk chart.…”