Sekhri Neha, Perel Pablo, Clayton Tim, Feder Gene S, Hemingway Harry, Timmis Adam
Department of Cardiology, Barts Heart Centre, London, UK.
London School of Hygiene and Tropical Medicine, London, UK.
Heart. 2016 Jun 1;102(11):869-75. doi: 10.1136/heartjnl-2015-308994. Epub 2016 Feb 29.
Diagnostic models used in the management of suspected angina provide no explicit information about prognosis. We present a new prognostic model of 10-year coronary mortality in patients presenting for the first time with suspected angina to complement the Diamond-Forrester diagnostic model of disease probability.
A multicentre cohort of 8762 patients with suspected angina was followed up for a median of 10 years during which 233 coronary deaths were observed. Developmental (n=4412) and validation (n=4350) prognostic models based on clinical data available at first presentation showed good performance with close agreement and the final model utilised all 8762 patients to maximise power. The prognostic model showed strong associations with coronary mortality for age, sex, chest pain typicality, smoking status, diabetes, pulse rate, and ECG findings. Model discrimination was good (C statistic 0.83), patients in the highest risk quarter accounting for 173 coronary deaths (10-year risk of death: 8.7%) compared with a total of 60 deaths in the three lower risk quarters. When the model was simplified to incorporate only Diamond-Forrester factors (age, sex and character of symptoms) it underestimated coronary mortality risk, particularly in patients with reversible risk factors.
For the first time in patients with suspected angina, a prognostic model is presented based on simple clinical factors available at the initial cardiological assessment. The model discriminated powerfully between patients at high risk and lower risk of coronary death during 10-year follow-up. Clinical utility was reflected in the prognostic value it added to the updated Diamond-Forrester diagnostic model of disease probability.
用于疑似心绞痛管理的诊断模型未提供关于预后的明确信息。我们提出了一种针对首次因疑似心绞痛就诊患者的10年冠状动脉死亡率的新预后模型，以补充疾病概率的Diamond-Forrester诊断模型。
对8762例疑似心绞痛患者的多中心队列进行了中位时间为10年的随访，在此期间观察到233例冠状动脉死亡。基于首次就诊时可用的临床数据建立的发育模型（n = 4412）和验证模型（n = 4350）显示出良好的性能，一致性良好，最终模型使用了所有8762例患者以最大化效能。该预后模型显示年龄、性别、胸痛典型性、吸烟状况、糖尿病、脉搏率和心电图结果与冠状动脉死亡率密切相关。模型的区分度良好（C统计量为0.83），风险最高四分位的患者中有173例冠状动脉死亡（10年死亡风险：8.7%），而在风险较低的三个四分位中共有60例死亡。当模型简化为仅纳入Diamond-Forrester因素（年龄、性别和症状特征）时，它低估了冠状动脉死亡风险，尤其是在具有可逆风险因素的患者中。
首次针对疑似心绞痛患者，基于初始心脏评估时可用的简单临床因素提出了一种预后模型。该模型在10年随访期间能有力地区分冠状动脉死亡高风险和低风险患者。临床实用性体现在它为更新后的疾病概率Diamond-Forrester诊断模型增加的预后价值上。
