TY - JOUR
T1 - Prognostic stratification of patients with vasospastic angina
T2 - A comprehensive clinical risk score developed by the Japanese coronary spasm association
AU - Takagi, Yusuke
AU - Takahashi, Jun
AU - Yasuda, Satoshi
AU - Miyata, Satoshi
AU - Tsunoda, Ryusuke
AU - Ogata, Yasuhiro
AU - Seki, Atsushi
AU - Sumiyoshi, Tetsuya
AU - Matsui, Motoyuki
AU - Goto, Toshikazu
AU - Tanabe, Yasuhiko
AU - Sueda, Shozo
AU - Sato, Toshiaki
AU - Ogawa, Satoshi
AU - Kubo, Norifumi
AU - Momomura, Shin Ichi
AU - Ogawa, Hisao
AU - Shimokawa, Hiroaki
N1 - Funding Information:
The authors have received funding from the Japan Heart Foundation , Tokyo, Japan.
PY - 2013/9/24
Y1 - 2013/9/24
N2 - Objectives The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients. Background Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important. Methods The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n = 1,429; median 66 years; median follow-up 32 months) was utilized for score derivation. Results Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-segment elevation during angina, and beta-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0 to 2, n = 598), intermediate (score 3 to 5, n = 639) and high (score 6 or more, n = 192). The incidences of MACE in the low-, intermediate-, and high-risk patients were 2.5%, 7.0%, and 13.0%, respectively (p < 0.001). The Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively. Conclusions We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients.
AB - Objectives The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients. Background Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important. Methods The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n = 1,429; median 66 years; median follow-up 32 months) was utilized for score derivation. Results Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-segment elevation during angina, and beta-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0 to 2, n = 598), intermediate (score 3 to 5, n = 639) and high (score 6 or more, n = 192). The incidences of MACE in the low-, intermediate-, and high-risk patients were 2.5%, 7.0%, and 13.0%, respectively (p < 0.001). The Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively. Conclusions We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients.
KW - angina
KW - arrhythmia
KW - coronary vasospasm
KW - ischemia
KW - prognosis
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U2 - 10.1016/j.jacc.2013.07.018
DO - 10.1016/j.jacc.2013.07.018
M3 - Article
C2 - 23916938
AN - SCOPUS:84884402425
VL - 62
SP - 1144
EP - 1153
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 13
ER -