Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients with chronic kidney disease

• Published in: Journal of nuclear cardiology Vol. 27; no. 1; pp. 41 - 50
• Main Authors: Nakajima, Kenichi, Nakamura, Satoko, Hase, Hiroki, Takeishi, Yasuchika, Nishimura, Shigeyuki, Kawano, Yuhei, Nishimura, Tsunehiko
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01-02-2020; Springer International Publishing; Springer Nature B.V
• Subjects: Aged; C-reactive protein; cardiac events; Cardiology; Cohort Studies; Ejection fraction; Female; Glomerular Filtration Rate; Heart Diseases - diagnostic imaging; Heart Diseases - epidemiology; Heart failure; Hospitalization; Humans; Imaging; Kidney diseases; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; multivariable logistic analysis; Myocardial Perfusion Imaging; Nuclear Medicine; Original; Original Article; Prognosis; Radiology; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Risk Assessment; Stroke Volume; Survival Analysis; eGFR; multivariable logistic analysis; heart failure; cardiac events; SSS; Prognosis; C-reactive protein; CAD; LVEF; MI; CKD; HF
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-018-1330-8

This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD).
Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m2, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m2.
The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m2, but patients with eGFR < 15 mL/min/1.73 m2 are potentially at high risk regardless of estimated risk values.