验证和比较 PROMISE 和 CONFIRM 模型以预测有症状和糖尿病患者的高危冠状动脉疾病。

Validation and Comparison of PROMISE and CONFIRM Model to Predict High-Risk Coronary Artery Disease in Symptomatic and Diabetes Mellitus Patients.

机构信息

Department of Cardiology, Tianjin Chest Hospital, 300000 Tianjin, China.

出版信息

Rev Cardiovasc Med. 2022 Mar 1;23(3):80. doi: 10.31083/j.rcm2303080.

DOI:10.31083/j.rcm2303080

PMID:35345247

Abstract

BACKGROUND

The identification of high-risk coronary artery disease (HRCAD) is important in diabetes mellitus (DM) patients. However, the reliability of current models to predict HRCAD has not been fully investigated. Thus, we aimed to validate and compare CONFIRM and PROMISE high-risk model (CHM and PHM) in DM patients.

METHODS

5936 symptomatic DM patients who underwent coronary computed tomographic angiography (CCTA) were identified. Probability of HRCAD for each patient was estimated based on CHM and PHM, respectively. We used Area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and Hosmer-Lemeshow (H-L) test to evaluate model's predictive accuracy.

RESULTS

Overall, 470 (8%) patients had HRCAD on CCTA. There was no difference between the AUC for CHM and PHM (0.744 v.s. 0.721, = 0.0873). Compared to CHM, PHM demonstrated a positive IDI (3.08%, < 0.0001), positive NRI (12.50%, < 0.0001) and less discrepancy between observed and predicted probabilities (H-L χ2 for CHM: 35.81, < 0.0001; H-L χ2 for PHM: 23.75, = 0.0025).

CONCLUSIONS

Compared to CHM, PHM was associated with a more accurate prediction for HRCAD and might optimize downstream management strategy in symptomatic patients with DM.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT04691037).

摘要

背景

识别高危冠状动脉疾病（HRCAD）在糖尿病患者中很重要。然而，目前预测 HRCAD 的模型的可靠性尚未得到充分研究。因此，我们旨在验证和比较 CONFIRM 和 PROMISE 高危模型（CHM 和 PHM）在糖尿病患者中的应用。

方法

共纳入 5936 例有症状的糖尿病患者，行冠状动脉计算机断层扫描血管造影（CCTA）检查。分别基于 CHM 和 PHM 评估每位患者发生 HRCAD 的概率。我们使用接受者操作特征曲线下面积（AUC）、综合判别改善（IDI）、净重新分类改善（NRI）和 Hosmer-Lemeshow（H-L）检验来评估模型的预测准确性。

结果

总体而言，5936 例患者中有 470 例（8%）在 CCTA 上有 HRCAD。CHM 和 PHM 的 AUC 之间没有差异（0.744 比 0.721， = 0.0873）。与 CHM 相比，PHM 显示出正的 IDI（3.08%， < 0.0001）、正的 NRI（12.50%， < 0.0001）和观察到的和预测到的概率之间的差异较小（CHM 的 H-L χ2：35.81， < 0.0001；PHM 的 H-L χ2：23.75， = 0.0025）。