Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, 920-8641, Japan.
Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan.
J Nucl Cardiol. 2020 Feb;27(1):41-50. doi: 10.1007/s12350-018-1330-8. Epub 2018 Jun 12.
This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD).
Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m.
The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m, but patients with eGFR < 15 mL/min/1.73 m are potentially at high risk regardless of estimated risk values.
本研究旨在验证多中心 J-ACCESS 预后研究中创建的主要事件风险模型在新的慢性肾脏病（CKD）患者队列中的准确性。
创建了三个多变量 J-ACCESS 风险模型来预测主要心脏事件（心脏死亡、非致死性急性冠脉综合征和需要住院治疗的严重心力衰竭）：模型 1，四个变量为年龄、总和应激评分、左心室射血分数和糖尿病；模型 2 包括五个变量，包括估计肾小球滤过率（eGFR，连续）；模型 3 为分类 eGFR。验证数据使用 CKD 患者三年（3y）队列（n=526，主要事件 11.2%）。所有三种模型的低（<3%/3y）、中（3%至 9%/3y）和高（>9%/3y）风险组的生存分析显示良好的分层（实际事件率：在 eGFR≥15 mL/min/1.73 m 的三组中分别为 3.1%、9.9%和 15.9%，P=0.0087（模型 2）。然而，在所有 eGFR<15 mL/min/1.73 m 的患者风险组中，实际事件率同样较高。
J-ACCESS 风险模型可对 CKD 和 eGFR≥15 mL/min/1.73 m 的患者进行分层，但无论估计的风险值如何，eGFR<15 mL/min/1.73 m 的患者存在潜在的高风险。
