Key result
VA SMART risk score predicts 10-year MACE in Veterans similarly to established models.
Why the study?
Estimating long-term cardiovascular event risk using the SMART risk score could be valuable for risk mitigation, but its application had not been evaluated in U.S. Veterans.
Does the VA SMART risk score accurately estimate the 10-year risk of composite MACE in U.S. Veterans referred for outpatient cardiology evaluation?
Cohort
Yes
Does the VA SMART risk score accurately estimate the 10-year risk of composite MACE in U.S. Veterans referred for outpatient cardiology evaluation?
Effect estimate: C-statistic 0.67
p-value: p=< 0.0001
The VA SMART risk score demonstrates moderate predictive ability (C-statistic 0.67) for estimating 10-year MACE risk in U.S. Veterans, performing similarly to other established models.
VA SMART may aid MACE risk estimation in veterans; hypothesis-generating and should not yet change practice.
Background: Estimation of long-term risk for cardiovascular events using the SMART (Secondary Manifestations of Arterial Disease) risk score can be potentially valuable in devising risk mitigation strategies. Objectives: The objective of this study was to apply the SMART risk score to compute the risk for major adverse cardiovascular events (MACE) in the U.S. Veteran patient population. Methods: We used the Veterans Affairs (VA) informatics and computing infrastructure to identify patients referred for an initial outpatient cardiology evaluation between the years 2003 and 2010 to estimate 10-year risk for composite MACE (all-cause death, ischemic stroke, and nonfatal myocardial infarction). Cox regression and survival curves were used to develop and validate the VA SMART score. Results: < 0.0001 for all intergroup comparisons). Most MACE events were all-cause death, with nonfatal myocardial infarction and stroke also being high, especially in the very high-risk group. The VA SMART score performed similar to other established risk prediction models (C-statistic = 0.67). Conclusions: The VA SMART risk score can estimate the long-term risk of recurrent cardiovascular events in U.S. Veterans and could help implement individualized risk mitigation strategies.
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Banerjee et al. (2024) conducted a cohort in Cardiovascular risk. VA SMART risk score vs. Other established risk prediction models was evaluated on 10-year risk for composite MACE (all-cause death, ischemic stroke, and nonfatal myocardial infarction) (C-statistic 0.67, p=< 0.0001). The VA SMART risk score estimated the 10-year risk of composite MACE in U.S. Veterans with performance similar to other established risk prediction models (C-statistic = 0.67).
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