title: Routinely available biomarkers improve prediction of long-term mortality in stable coronary artery disease: the Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) risk score.
abstract: OBJECTIVE
  Previous risk assessment scores for patients with coronary artery disease (CAD) have focused on primary prevention and patients with acute coronary syndrome. However, especially in stable CAD patients improved long-term risk prediction is crucial to efficiently apply measures of secondary prevention. We aimed to create a clinically applicable mortality prediction score for stable CAD patients based on routinely determined laboratory biomarkers and clinical determinants of secondary prevention.
  
  
  RESULTS
  We prospectively included 547 patients with stable CAD and a median follow-up of 11.3 years. Independent risk factors were selected using bootstrapping based on Cox regression analysis. Age, left ventricular function, serum cholinesterase, creatinine, heart rate, and HbA1c were selected as significant mortality predictors for the final multivariable model. The Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) risk score based on the aforementioned variables demonstrated an excellent discriminatory power for 10-year survival with a C-statistic of 0.77 (P < 0.001), which was significantly better than an established risk score based on conventional cardiovascular risk factors (C-statistic = 0.61, P < 0.001). Net reclassification confirmed a significant improvement in individual risk prediction by 34.8% (95% confidence interval: 21.7-48.0%) compared with the conventional risk score (P < 0.001). External validation of the risk score in 1275 participants of the Ludwigshafen Risk and Cardiovascular Health study (median follow-up of 9.8 years) achieved similar results (C-statistic = 0.73, P < 0.001).
  
  
  CONCLUSIONS
  The VILCAD score based on a routinely available set of risk factors, measures of cardiac function, and comorbidities outperforms established risk prediction algorithms and might improve the identification of high-risk patients for a more intensive treatment.
authors: Division of Cardiology and Angiology, Department of Internal Medicine II,  Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090,  Austria.
authors: Georg
authors: G
authors: Goliasch
authors: Marcus E
authors: ME
authors: Kleber
authors: Bernhard
authors: B
authors: Richter
authors: Max
authors: M
authors: Plischke
authors: Matthias
authors: M
authors: Hoke
authors: Arvand
authors: A
authors: Haschemi
authors: Rodrig
authors: R
authors: Marculescu
authors: Georg
authors: G
authors: Endler
authors: Tanja B
authors: TB
authors: Grammer
authors: Stefan
authors: S
authors: Pilz
authors: Andreas
authors: A
authors: Tomaschitz
authors: Günther
authors: G
authors: Silbernagel
authors: Gerald
authors: G
authors: Maurer
authors: Oswald
authors: O
authors: Wagner
authors: Kurt
authors: K
authors: Huber
authors: Winfried
authors: W
authors: März
authors: Christine
authors: C
authors: Mannhalter
authors: Alexander
authors: A
authors: Niessner
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers