Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients.
Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients.
复制标题
DOI：
10.1093/eurheartj/eht533
复制
发表时间：
2014-04
影响因子：
39.3
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Rapsomaniki E;Shah A;Perel P;Denaxas S;George J;Nicholas O;Udumyan R;Feder GS;Hingorani AD;Timmis A;Smeeth L;Hemingway H
患有稳定型冠状动脉疾病 (SCAD) 的人群正在增长，但缺乏指导其临床管理的经过验证的模型。我们开发并验证了 SCAD 中全因死亡率和非致命性心肌梗死 (MI) 或冠心病死亡的预后模型。模型是在 CALIBRE 项目的 102 023 名 SCAD 患者的关联电子健康记录队列中开发的，平均随访时间为 4.4 (SD 2.8) 年，期间观察到 20 817 例死亡和 8856 例冠心病结局。 Kaplan-Meier 5 年死亡率风险为 20.6%（95% CI，20.3，20.9），非致命性 MI 或冠心病死亡风险为 9.7%（95% CI，9.4，9.9）。模型中的预测因素包括年龄、性别、CAD诊断、剥夺、吸烟、高血压、糖尿病、血脂、心力衰竭、外周动脉疾病、心房颤动、中风、慢性肾病、慢性肺病、肝病、癌症、抑郁、焦虑、心率、肌酐、白细胞计数和血红蛋白。该模型在内部（外部）验证中具有良好的校准和区分能力，全因死亡率的 C 指数为 0.811 (0.735)，非致命性 MI 或冠心病死亡的 C 指数为 0.778 (0.718)。与仅考虑年龄、性别和剥夺程度的模型相比，使用这些模型来识别高危患者（指南将其定义为每年 3% 的死亡率）并支持与风险比 0.8 相关的管理决策，每 1000 名筛查患者可以额外节省 13-16 生命年或 15-18 年无冠状动脉事件年。这些经过验证的预后模型可用于临床实践，以支持临床指南中建议的风险分层。
The population with stable coronary artery disease (SCAD) is growing but validated models to guide their clinical management are lacking. We developed and validated prognostic models for all-cause mortality and non-fatal myocardial infarction (MI) or coronary death in SCAD. Models were developed in a linked electronic health records cohort of 102 023 SCAD patients from the CALIBER programme, with mean follow-up of 4.4 (SD 2.8) years during which 20 817 deaths and 8856 coronary outcomes were observed. The Kaplan–Meier 5-year risk was 20.6% (95% CI, 20.3, 20.9) for mortality and 9.7% (95% CI, 9.4, 9.9) for non-fatal MI or coronary death. The predictors in the models were age, sex, CAD diagnosis, deprivation, smoking, hypertension, diabetes, lipids, heart failure, peripheral arterial disease, atrial fibrillation, stroke, chronic kidney disease, chronic pulmonary disease, liver disease, cancer, depression, anxiety, heart rate, creatinine, white cell count, and haemoglobin. The models had good calibration and discrimination in internal (external) validation with C-index 0.811 (0.735) for all-cause mortality and 0.778 (0.718) for non-fatal MI or coronary death. Using these models to identify patients at high risk (defined by guidelines as 3% annual mortality) and support a management decision associated with hazard ratio 0.8 could save an additional 13–16 life years or 15–18 coronary event-free years per 1000 patients screened, compared with models with just age, sex, and deprivation. These validated prognostic models could be used in clinical practice to support risk stratification as recommended in clinical guidelines.
登录
查看更多内容
影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
DOI：
10.1136/bmj.e5595
发表时间：
2013-02-05
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Hemingway H;Croft P;Perel P;Hayden JA;Abrams K;Timmis A;Briggs A;Udumyan R;Moons KG;Steyerberg EW;Roberts I;Schroter S;Altman DG;Riley RD;PROGRESS Group
通讯作者：
PROGRESS Group
影响因子：
2.8
作者：
Hirsch, Alexander;Verouden, Niels J. W.;de Winter, Robbert J.
通讯作者：
de Winter, Robbert J.
影响因子：
105.7
作者：
Hippisley-Cox, Julia;Coupland, Carol;Brindle, Peter
通讯作者：
Brindle, Peter
影响因子：
7.7
作者：
Denaxas SC;George J;Herrett E;Shah AD;Kalra D;Hingorani AD;Kivimaki M;Timmis AD;Smeeth L;Hemingway H
通讯作者：
Hemingway H