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. 2023 Apr;30(2):702-707.
doi: 10.1007/s12350-022-02964-z. Epub 2022 Apr 13.

External validation of the CRAX2MACE model

Waseem Hijazi  1 , Willam Leslie  2 , Neil Filipchuk  1 , Ryan Choo  1 , Stephen Wilton  1 , Matthew James  3 , Piotr J Slomka  4 , Robert J H Miller  5
Affiliations

External validation of the CRAX2MACE model

Waseem Hijazi et al. J Nucl Cardiol. 2023 Apr.

Abstract

Background: Single-photon emission computed tomography (SPECT) myocardial perfusion is frequently used to predict risk of major adverse cardiovascular events (MACE). We performed an external validation of the CRAX2MACE score, developed to estimate 2-year risk of MACE in patients with suspected coronary artery disease (CAD).

Methods: Patients who underwent clinically indicated SPECT with available follow-up for MACE were included (N = 2,985). The prediction performance for MACE (revascularization, myocardial infarction, or death) within 2 years for CRAX2MACE was compared with stress and ischemic total perfusion deficit (TPD) using area under the receiver operating characteristic curve (AUC). Calibration was assessed with calibration plots, Brier score, and the Hosmer-Lemeshow test.

Results: MACE occurred within 2 years in 243 (8.1%) patients. The AUC for CRAX2MACE (0.710, 95% CI 0.677-0.743) was significantly higher compared to stress TPD (AUC 0.669, 95% CI 0.632-0.706, P = .010) and ischemic TPD (AUC 0.664, 95% CI 0.627-0.700, P < .001). The model had acceptable goodness-of-fit (P = .103) and was well-calibrated with Brier score of 0.071.

Conclusion: CRAX2MACE had higher predictive performance for 2-year MACE than quantitative perfusion in an external population. The current model is simple to use and could be implemented to assist physicians when estimating patient risk.

Keywords: MPI; Risk stratification; SPECT; myocardial perfusion imaging.

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Figures

Figure 1:
Figure 1:. Prediction Performance for 2-year MACE
Prediction performance for major adverse cardiovascular events (MACE) during 2-years of follow-up. MACE included revascularization, non-fatal myocardial infarction, and all-cause mortality. AUC – area under the receiver operating characteristic curve, CI – confidence interval, TPD – total perfusion deficit.
Figure 2:
Figure 2:. Prediction Performance for 2-year Death or MI
Prediction performance for death or non-fatal myocardial infarction (MI) during 2-years of follow-up. AUC – area under the receiver operating characteristic curve, CI – confidence interval, TPD – total perfusion deficit.
Figure 3:
Figure 3:. Calibration plot for CRAX2MACE model
Calibration plot outlining predicted risk and observed rate of major adverse cardiovascular events (MACE) during 2-years of follow-up.
See this image and copyright information in PMC

References

    1. Otaki Y, Betancur J, Sharir T, Hu L, Gransar H, Liang J et al. 5-Year Prognostic Value of Quantitative Versus Visual MPI in Subtle Perfusion Defects. JACC Cardiovasc Imaging 2020;13(3):774–785. - PMC - PubMed
    1. Rozanski A, Gransar H, Hayes S, Min J, Friedman J, Thomson L et al. Temporal Trends in the Frequency of Inducible Myocardial Ischemia During Cardiac Stress Testing. J Am Coll Cardiol 2013;61(10):1054–1065. - PubMed
    1. Shaw L. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004;11(2):171–185. - PubMed
    1. Leslie W, Bryanton M, Goertzen A, Slomka P. Prediction of 2-year major adverse cardiac events from myocardial perfusion scintigraphy and clinical risk factors. J Nucl Cardiol 2021; Epub ahead of print. - PMC - PubMed
    1. Megna R, Petretta M, Assante R, Zampella E, Nappi C, Gaudieri V et al. External validation of the CRAX2MACE model in an Italian cohort of patients with suspected coronary artery disease undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2021; Epub ahead of print. - PubMed

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