Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow G12 8QQ, UK.
Cardiology Department, Institut Coeur Poumon, CHU, Université de Lille, Bd du Professeur Jules Leclercq, 59000 Lille, France.
Eur Heart J Qual Care Clin Outcomes. 2021 May 3;7(3):287-294. doi: 10.1093/ehjqcco/qcz070.
Risk estimation is important to motivate patients to adhere to treatment and to identify those in whom additional treatments may be warranted and expensive treatments might be most cost effective. Our aim was to develop a simple risk model based on readily available risk factors for patients with stable coronary artery disease (CAD).
Models were developed in the CLARIFY registry of patients with stable CAD, first incorporating only simple clinical variables and then with the inclusion of assessments of left ventricular function, estimated glomerular filtration rate, and haemoglobin levels. The outcome of cardiovascular death over ∼5 years was analysed using a Cox proportional hazards model. Calibration of the models was assessed in an external study, the CORONOR registry of patients with stable coronary disease. We provide formulae for calculation of the risk score and simple integer points-based versions of the scores with associated look-up risk tables. Only the models based on simple clinical variables provided both good c-statistics (0.74 in CLARIFY and 0.80 or over in CORONOR), with no lack of calibration in the external dataset.
Our preferred model based on 10 readily available variables [age, diabetes, smoking, heart failure (HF) symptom status and histories of atrial fibrillation or flutter, myocardial infarction, peripheral arterial disease, stroke, percutaneous coronary intervention, and hospitalization for HF] had good discriminatory power and fitted well in an external dataset.
The CLARIFY registry is registered in the ISRCTN registry of clinical trials (ISRCTN43070564).
风险评估对于激励患者坚持治疗以及识别那些可能需要额外治疗且昂贵治疗可能最具成本效益的患者非常重要。我们的目的是为稳定型冠状动脉疾病（CAD）患者建立一个基于易于获得的风险因素的简单风险模型。
在 CLARIFY 稳定型 CAD 患者登记处建立了模型，首先仅纳入简单的临床变量，然后纳入左心室功能、估算肾小球滤过率和血红蛋白水平的评估。使用 Cox 比例风险模型分析了约 5 年内心血管死亡的结果。在稳定型冠状动脉疾病患者的 CORONOR 登记处的外部研究中评估了模型的校准。我们提供了计算风险评分的公式以及简单的整数点版本的评分，以及相关的查找风险表。只有基于简单临床变量的模型提供了良好的 c 统计量（CLARIFY 中为 0.74，CORONOR 中为 0.80 或更高），外部数据集不存在校准不足的情况。
我们首选的模型基于 10 个易于获得的变量[年龄、糖尿病、吸烟、心力衰竭（HF）症状状态和心房颤动或扑动、心肌梗死、外周动脉疾病、中风、经皮冠状动脉介入治疗以及 HF 住院治疗的病史]，具有良好的区分能力，并在外部数据集中拟合良好。
CLARIFY 登记处已在临床试验 ISRCTN 登记处（ISRCTN43070564）注册。
