Key result
The VILCAD risk score yielded a C-statistic of 0.77 for 10-year survival, improving individual risk prediction by 34.8% (95% CI 21.7-48.0%; P<0.001) compared with a conventional risk score.
Why the study?
Does the VILCAD risk score improve prediction of long-term mortality in patients with stable coronary artery disease compared to conventional risk scores?
Cohort (n=1,822)
Yes
Does the VILCAD risk score improve prediction of long-term mortality in patients with stable coronary artery disease compared to conventional risk scores?
Effect estimate: Net reclassification improvement 34.8% (95% CI 21.7-48.0)
p-value: p=<0.001
The VILCAD risk score, utilizing routinely available biomarkers and clinical parameters, significantly improves long-term mortality prediction in stable CAD patients compared to conventional risk scores.
May support refined mortality stratification in stable CAD using routine data; leaves open prospective validation before clinical adoption.
AIMS: 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. METHODS AND 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). CONCLUSION: 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.
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Goliasch et al. (2012) conducted a cohort in Stable coronary artery disease (n=1,822). VILCAD risk score vs. Established risk score based on conventional cardiovascular risk factors was evaluated on 10-year survival (Net reclassification improvement 34.8%, 95% CI 21.7-48.0, p=<0.001). The VILCAD risk score yielded a C-statistic of 0.77 for 10-year survival, improving individual risk prediction by 34.8% (95% CI 21.7-48.0%; P<0.001) compared with a conventional risk score.
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