Nomogram to Predict Survival in Asymptomatic Patients Using CACS

Jun 21, 2017
Font Size
A
A
A
Authors:
O’Hartaigh BO, Gransar H, Callister T, et al.
Citation:
Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring. JACC Cardiovasc Imaging 2017;Jun 14:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

How valid is a simple-to-use nomogram for prediction of 5-, 10-, and 15-year survival among asymptomatic adults utilizing coronary artery calcium scoring (CACS)?

Methods:

A total of 9,715 persons (mean age, 53.4 ± 10.5 years; 59.3% male) physician referred for a CACS were used to develop a nomogram using Cox proportional hazards regression modeling that included: age, sex, smoking, hypertension, dyslipidemia, diabetes, family history of coronary artery disease, and CACS. A prognostic index (PI) summing the number of risk points corresponding to weighted covariates was used to configure the nomogram.

Results:

A total of 936 and 294 deaths occurred in the derivation and validation sets at a median follow-up of 14.6 years (interquartile range, 13.7-15.5 years) and 9.4 years (interquartile range, 6.8-11.5 years), respectively. The developed model effectively predicted 5-, 10-, and 15-year probability of survival. The PI displayed high discrimination in the derivation and validation sets (C-index 0.74 and 0.76, respectively).

Conclusions:

A simple-to-use nomogram effectively predicts 5-, 10-, and 15-year survival for asymptomatic adults undergoing screening for cardiac risk factors. This nomogram may be considered for use in clinical care.

Perspective:

While the relative accuracy of predicting all-cause mortality using the tool is much better than intuitive, it has little clinical application compared to the MESA (Multi-Ethnic Study of Atherosclerosis) study that uses coronary risk factor values and CACS to predict 10-year coronary heart disease risk, and the Reynold Risk Score that incorporates high-sensitivity C-reactive protein and risk factors to predict 10-year risk of coronary heart disease and stroke.

Keywords: Cardiac Imaging Techniques, Coronary Artery Disease, Diabetes Mellitus, Dyslipidemias, Hypertension, Nomograms, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Smoking, Survival


< Back to Listings