title: Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association.
abstract: OBJECTIVE
  The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients.
  
  
  BACKGROUND
  Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important.
  
  
  METHODS
  The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n = 1,429; median 66 years; median follow-up 32 months) was utilized for score derivation.
  
  
  RESULTS
  Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-segment elevation during angina, and beta-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0 to 2, n = 598), intermediate (score 3 to 5, n = 639) and high (score 6 or more, n = 192). The incidences of MACE in the low-, intermediate-, and high-risk patients were 2.5%, 7.0%, and 13.0%, respectively (p < 0.001). The Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively.
  
  
  CONCLUSIONS
  We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients.
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takagi
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyata
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Tsunoda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Matsui
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Goto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Shozo
authors.initials: S
authors.lastname: Sueda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kubo
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Momomura
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D003329:Coronary Vasospasm / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: AIC; Akaike Information Criterion; ECG; HR; ICD; IQR; JCSA; Japanese Coronary Spasm Association; MACE; OHCA; SD; VSA; angina; arrhythmia; coronary vasospasm; electrocardiography; hazard ratio; implantable cardioverter-defibrillator; interquartile range; ischemia; major adverse cardiac event; out-of-hospital cardiac arrest; prognosis; standard deviation; vasospastic angina