A simple model to predict coronary disease in patients undergoing operation for mitral regurgitation.
BACKGROUND
Coexistent coronary disease can be identified in a third of patients with mitral valve disease. This study aims to evaluate candidate selection strategy using risk factor identification and logistic regression and to develop an additive model for the prediction of coexistent coronary disease.


METHODS
The sample is a consecutive series of patients who had mitral repair from 1987 to 1999. Sensitivities and specificities were calculated for each risk factor. Variables for prediction of coronary disease were entered into a univariate analysis, and predictors were entered into a forward and backward stepwise multivariate logistic regression model to form a predictive score. An additive model was derived from transformation of the logistic model. Receiver operating characteristic curves were used to compare discrimination and precision quantified by the Hosmer-Lemeshow statistic.


RESULTS
The American Heart Association and American College of Cardiology risk factor identification selection criteria for the 359 patients who had screening coronary angiography yielded 100% sensitivity and 1% specificity. Risk prediction with our logistic model produced a receiver operating characteristic curve area of 0.91 and Hosmer-Lemeshow score of 3.4 (p = 0.9). Similar discriminating ability for our patients was achieved by the Cleveland Clinic logistic model (receiver operator characteristic curve area of 0.79; Hosmer-Lemeshow score of 12; p = 0.1). Our five-item additive model produced receiver operating characteristic curve area of 0.91 and Hosmer-Lemeshow score of 3.81 (p = 0.80).


CONCLUSIONS
Simple risk factor identification has excellent sensitivity but is limited by specificity. Logistic regression modeling is an accurate risk prediction method but is difficult to apply at the bedside. Simplicity and accuracy may be achieved by the logistic regression-derived simple additive model.
Lim
Eric
E
Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom. ericlim2@hotmail.com
Ali
Ziad A
ZA
Barlow
Clifford W
CW
Jackson
Christopher H
CH
Hosseinpour
Amir-Reza
AR
Halstead
James C
JC
Barlow
John B
JB
Wells
Francis C
FC
D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D016019:Survival Analysis