title: Development and validation of a cardiovascular risk assessment model in patients with established coronary artery disease.
abstract: Appropriate risk stratification of patients with established, stable coronary artery disease could contribute to the prevention of recurrent cardiovascular events. The purpose of the present study was to develop and validate risk prediction models for various cardiovascular end points in the EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) database, consisting of 12,218 patients with established coronary artery disease, with a median follow-up of 4.1 years. Cox proportional hazards models were used for model development. The end points examined were cardiovascular mortality, noncardiovascular mortality, nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, resuscitated cardiac arrest, and combinations of these end points. The performance measures included Nagelkerke's R², time-dependent area under the receiver operating characteristic curves, and calibration plots. Backward selection resulted in a prediction model for cardiovascular mortality (464 events) containing age, current smoking, diabetes mellitus, total cholesterol, body mass index, previous myocardial infarction, history of congestive heart failure, peripheral vessel disease, previous revascularization, and previous stroke. The model performance was adequate for this end point, with a Nagelkerke R² of 12%, and an area under the receiver operating characteristic curve of 0.73. However, the performance of models constructed for nonfatal and combined end points was considerably worse, with an area under the receiver operating characteristic curve of about 0.6. In conclusion, in patients with established coronary artery disease, the risk of cardiovascular mortality during longer term follow-up can be adequately predicted using the clinical characteristics available at baseline. However, the prediction of nonfatal outcomes, both separately and combined with fatal outcomes, poses major challenges for clinicians and model developers.
authors.affiliation: Clinical Epidemiology Unit, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Battes
authors.forename: Rogier
authors.initials: R
authors.lastname: Barendse
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Daan
authors.initials: D
authors.lastname: Nieboer
authors.forename: Michel
authors.initials: M
authors.lastname: Bertrand
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Remme
authors.forename: Kim
authors.initials: K
authors.lastname: Fox
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Isabella
authors.initials: I
authors.lastname: Kardys
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019540:Area Under Curve; D002138:Calibration; D002318:Cardiovascular Diseases / Q000401:mortality*; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril