Limitations of a conventional logistic regression model based on left ventricular ejection fraction in predicting coronary events after myocardial infarction.
The clinical utility of conventional logistic regression models based on left ventricular ejection fraction (LVEF) for the prediction of cardiac events (death or recurrent infarction) was assessed in 646 postinfarction patients undergoing radionuclide ventriculography at rest and during exercise. The discriminant power of 2 different models (LVEF at rest alone vs LVEF at rest plus LVEF at peak exercise) was quantified in terms of the area under receiver-operating characteristic curves based on knowledge of patient outcome in the year after testing and the logistic probability of that outcome. Although LVEF at rest provided a significant amount of prognostic information (receiver-operating characteristic curve area = 62 +/- 4%, p less than 0.001), several limitations were observed: (1) powerful predictors of risk were uncommon (32% of patients with an LVEF at rest less than 0.20 had a cardiac event, but only 3% of the population had such extreme values); (2) the accuracy of predictions for high risk patients was less than for low risk patients (28 vs 98%, p less than 0.001); (3) addition of exercise LVEF to the model did not improve the accuracy of prediction (receiver-operating characteristic curve area = 68 +/- 4%, p = 0.11); and (4) predictions for individual patients were very imprecise (the 95% confidence interval of percent risk for an LVEF at rest of 0.20 [11 to 36%] overlapped that for an LVEF at rest of 0.60 [0 to 14%]).(ABSTRACT TRUNCATED AT 250 WORDS)
Work
J W
JW
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Ferguson
J G
JG
Diamond
G A
GA
D003645:Death, Sudden; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D011379:Prognosis; D015635:Radionuclide Ventriculography; D012008:Recurrence; D013318:Stroke Volume; D013997:Time Factors