J-ACCESS研究的预后模型在临床环境中预测心脏事件的能力：APPROACH研究。
Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study.
作者信息
Aburadani Isao, Usuda Kazuo, Sumiya Hisashi, Sakagami Satoru, Kiyokawa Hiroaki, Matsuo Shinro, Takamura Masayuki, Murai Hisayoshi, Takashima Shinichiro, Kitano Teppei, Okuda Koichi, Nakajima Kenichi
机构信息
Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan.
Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan.
出版信息
J Cardiol. 2018 Jul;72(1):81-86. doi: 10.1016/j.jjcc.2017.12.006. Epub 2018 Jan 6.
BACKGROUND
In patients with coronary artery disease (CAD), one of the risk models available in Japan was a multivariate risk prediction model based on a Japanese multicenter database: the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS). The aim of this study was to clinically validate the accuracy of this risk model.
METHODS
We evaluated the performance of the J-ACCESS model using data derived from the Assessment of the Predicted value of PROgnosis of cArdiaC events in Hokuriku (APPROACH) registry. Variables of age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus were included. The major cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure that required hospitalization. The patients were followed up for three years to compare between predicted risk and actual events.
RESULTS
We evaluated 283 patients with suspected or confirmed CAD receiving myocardial perfusion imaging using Tc-tetrofosmin between March 2009 and August 2011. Mean age was 68.9±10.1 years, mean eGFR 67.4±24.3mL/min/1.73m, mean SSS 5.2±7.2, and mean LVEF 65.4±14.0%. Fourteen (4.9%) patients experienced major cardiac events including cardiac death in 4 patients (1.4%), non-fatal myocardial infarction in 1 patient (0.3%), and severe heart failure in 9 patients (3.2%), respectively. While SSS≥8, LVEF<50%, eGFR<45mL/min/1.73m, and event risk≥10% were significant variables in survival analysis, multivariate proportional hazard analysis showed that only LVEF and eGFR were significant. The event rate estimated from the J-ACCESS model was comparable to the actual number of major cardiac events (9 and 6, respectively, p=0.58 by Chi-square test).
CONCLUSIONS
The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice.
背景
在冠状动脉疾病（CAD）患者中，日本现有的一种风险模型是基于日本多中心数据库的多变量风险预测模型：定量门控单光子发射计算机断层扫描日本心脏事件与生存评估研究（J-ACCESS）。本研究的目的是对该风险模型的准确性进行临床验证。
方法
我们使用来自北陆地区心脏事件预后预测评估（APPROACH）登记处的数据评估J-ACCESS模型的性能。纳入的变量有年龄、总应激评分（SSS）、左心室射血分数（LVEF）、估算肾小球滤过率（eGFR）和糖尿病。主要心脏事件定义为心源性死亡、非致命性心肌梗死以及需要住院治疗的心力衰竭。对患者进行了三年的随访，以比较预测风险与实际事件。
结果
我们评估了2009年3月至2011年8月期间283例疑似或确诊CAD且接受锝 - 替曲膦心肌灌注显像的患者。平均年龄为68.9±10.1岁，平均eGFR为67.4±24.3mL/min/1.73m²，平均SSS为5.2±7.2，平均LVEF为65.4±14.0%。14例（4.9%）患者发生了主要心脏事件，分别为4例（1.4%）心源性死亡、1例（0.3%）非致命性心肌梗死和9例（3.2%）严重心力衰竭。虽然在生存分析中SSS≥8、LVEF<50%、eGFR<45mL/min/1.73m²以及事件风险≥10%是显著变量，但多变量比例风险分析显示只有LVEF和eGFR是显著的。J-ACCESS模型估计的事件发生率与主要心脏事件的实际数量相当（分别为9例和6例，卡方检验 p = 0.58）。
结论
J-ACCESS风险模型在CAD患者中的预测能力在临床上是有效的，并且可应用于临床实践。
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