Development And Evaluation Of A Scoring System For Predicting Long-term Ischemia Events In Patients With Coronary Artery Disease Receiving Antiplatelet Therapy

Objective:We sought to develop a scoring system for predicting long-term ischemic events in CAD(coronary artery disease)patients receiving antiplatelet therapy with and to facilitate the appropriate personalized decision-making for these patients.Methods:In the prospective Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease(OPT-CAD,the US National Institutes of Health,clinicaltrials.gov registration number:NCT01735305)registry,a total of 14,032 CAD patients receiving at least one kind of antiplatelet agent were enrolled in 107 Chinese sites from January 2012 to March 2014.The risk scoring system was developed in a derivation cohort(enrolled initially 10,000 patients in the database)using a logistic regression model and was subsequently tested in a validation cohort(the last 4,032 patients).Points in risk score was assigned based on the multivariable odds ratio of each factor.The primary endpoint of this study was 12-month MACCE(major adverse cardiac and cerebral events),which was defined as the composite of all-cause death,myocardial infarction,any revascularization,or stroke.Ischemic events was defined as the composite of cardiac death,myocardial infarction and/or stroke.Results:The incidence of MACCE at 12 months were 8.5%in whole cohort.Ischemic events occurred in 342 patients(3.4%)in the derivation cohort and 160 patients(4.0%)in the validation cohort through 1 year follow-up.The OPT-CAD score,ranging from 0 to 257 points,consist of 10 independent risk factors,including age(0 to 71 points),heart rates(0 to 36 points),hypertension(0 to 20 points),prior myocardial infarction(16 points),prior stroke(16 points),renal insufficient(21 points),anemia(19 points),low ejection fraction(22 points),positive cardiac troponin(23 points)and ST-segment deviation(13 points).In predicting 1-year ischemic events,the area under receiver operating characteristics curve were 0.73 for derivation cohort.The incidences of ischemic events in low-(0～95 points),medium-(96～130 points)and high-risk(≥131 points)patients were 1.6%～5.5%,and 12.7%,respectively.Comparing with the observed risks for ischemic events,the predicted risks in any of three groups were well matched(p>0.05).Comparing with the GRACE score,OPT-CAD score had a better discrimination in predicting ischemic events and all-cause mortality(ischemic events:0.72 vs 0.65,all-cause mortality:0.79 vs 0.72,both p<0.001).Conclusions:Among CAD patients,a risk score based on 10 baseline clinical variables performed better than the GRACE risk score in predicting long-term ischemic events.Further research is needed to assess the value of the score in guiding the management of secondary prevention for patients with CAD.