Key result
Vall d'Hebron Risk Score-II accurately predicts MI and cardiac death with a C-statistic of ~0.81.
Why the study?
A new risk score integrating clinical, exercise, and gated SPECT variables was needed to stratify risk of non-fatal MI and cardiac death excluding patients with coronary revascularisation during follow-up.
Cohort (n=5,215)
No
The Vall d'Hebron Risk Score-II (VH-RS-II), integrating clinical, exercise, and gated SPECT variables, provides effective predictive accuracy for non-fatal MI and cardiac death in patients evaluated for coronary artery disease.
OBJECTIVES: The aim of this study was to create a new Vall d'Hebron Risk Score-II (VH-RS-II) for non-fatal myocardial infarction (MI) and/or cardiac death (CD), excluding patients with coronary revascularisation (CR) during the follow-up. METHODS: We analysed 5215 consecutive patients underwent gated single photon emission CT (SPECT); 2960 patients (age 64.2±11, male 58.1%) had no previous MI and/or CR, and 2255 patients (age 63.3±11, male 81.9%) had previous MI and/or CR. During a follow-up of 4.3±2.6 years, the cardiac event (MI and CD) was evaluated. This study was reviewed and approved by the ethics committee of our institution (number form trial register, PR(AG)168.2012). To obtain the predictor model, multivariate Cox regression analysis and multivariate logistic regression analysis were used. RS-VH-II was validated with 679 patients. RESULTS: In patients without previous MI and/or CR, age (HR: 1.01; p<0.001), diabetes (HR: 2.1, p=0.001), metabolic equivalent (METs) (HR: 0.89, p=0.038), ST segment depression (HR: 1.4, p=0.011), ejection fraction (EF) (HR: 0.97, p<0.001) and summed stress score (HR: 1.2, p<0.001) were the independent predictors of CE (C-statistic: 0.8). In patients with previous MI and/or CR, age (HR: 1.06, p<0.001), male (HR: 1.9, p=0.047), smoker (HR: 1.5, p=0.047), METs (HR: 0.8, p<0.001), ST segment depression (HR: 1.4, p=0.002), EF (HR: 0.96; p<0.001) and summed difference score (HR: 1.03, p=0.06) were the independent predictors of CE (C-statistic:0.8). CONCLUSION: The VH-RS-II obtained from different clinical exercise and gated SPECT variables allow the risk stratification for MI and CD in patients with or without previous MI and/or CR in due form.
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Romero-Farina et al. (2023) conducted a cohort in Suspected or established coronary artery disease (n=5,215). Vall d'Hebron Risk Score-II (VH-RS-II) vs. Lower risk categories was evaluated on Composite of non-fatal myocardial infarction and cardiac death (C-statistic 0.81, 95% CI 0.75-0.85, p=<0.001). The Vall d'Hebron Risk Score-II, integrating clinical, exercise, and gated SPECT variables, effectively stratified the risk of non-fatal myocardial infarction and cardiac death, achieving a C-statistic of 0.81.
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