Academic Journal
Identification of vascular patients at very high risk for recurrent cardiovascular events: validation of the current ACC/AHA very high risk criteria.
| Title: | Identification of vascular patients at very high risk for recurrent cardiovascular events: validation of the current ACC/AHA very high risk criteria. |
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| Authors: | van den Berg, M. Johanneke, Bhatt, Deepak L., Kappelle, L. Jaap, de Borst, Gert J., Cramer, Maarten J., van der Graaf, Yolanda, Steg, Gabriel, Visseren, Frank L. J. |
| Source: | European Heart Journal; 11/14/2017, Vol. 38 Issue 43, p3211-3218, 8p, 1 Chart, 3 Graphs |
| Abstract: | Aims To validate and assess performance of the current ACC/AHA very high risk criteria in patients with clinically manifest arterial disease. Methods and results Data were used from the SMART study (n = 7216) and REACH Registry (n = 48 322), two prospective cohorts of patients with manifest atherosclerotic arterial disease. Prevalence and incidence rates of recurrent major adverse cardiovascular events (MACE) were calculated, according to the ACC/AHA VHR criteria (cardiovascular disease combined with diabetes, smoking, dyslipidaemia, and/or recent recurrent coronary events). Performance of the ACC/AHA criteria was compared with single very high risk factors in terms of C-statistics and Net Reclassification Index. All patients were at VHR according to the ESC guidelines (incidence of recurrent MACE in SMART was 2.4/100PY, with 95% CI 2.3-2.5/100PY and in REACH 5.1/100PY with 95% CI 5.0-5.3/100PY). In SMART 57% of the patients were at VHR according to the ACC/AHA criteria (incidence of recurrent MACE 2.7/100PY, 95% CI 2.5- 2.9/100PY) and in REACH this was 64% (5.9/100PY, 95% CI 5.7-6.1/100PY). The C-statistic for the ACC/AHA VHR criteria was 0.53 in REACH and 0.54 in SMART. Very high risk factors with comparable or slightly better performance were eGFR < 45, polyvascular disease and age >70 years. Around two third of the patients meeting the ACC/AHA VHR criteria had a predicted 10-year risk of recurrent MACE <30%. Conclusion The ACC/AHA VHR criteria have limited discriminative power. Identifying patients with clinically manifest arterial disease at VHR for recurrent vascular events using eGFR <45, polyvascular disease, or age >70 years performs as well as the ACC/AHA VHR criteria. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 0195668X |
| DOI: | 10.1093/eurheartj/ehx102 |
| Database: | Complementary Index |
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