19 августа, 2021

New score predicts coronary heart disease and its course

The scores showed high precision in predicting outcomes across the disease continuum, from stenosis to recurrent myocardial infarction to death.

Insight

  • A novel score derived from a machine learning model using electronic health data demonstrated high accuracy in predicting coronary artery disease (CHD) outcomes across the disease spectrum.

Why this matters

  • The results can help identify individuals with undiagnosed disease and support management in individuals with diagnosed disease.

Study design

  • Cohort study for model development and validation using electronic medical records of 95.935  adults aged ≥ 40  years from the US-_ BioMe Biobank and the UK  Biobank
  • In both cohorts, 14 % of participants had a diagnosis of CHD.
  • A machine learning model was applied to calculate the probabilities of CHD outcomes occurring in the form of an in-silico CAD [ISCAD] score.
  • Main results: stenosis of the coronary arteries, obstructive-_ CHD, multi-vascular CHD, death of any cause, CHD sequelae (recurrent myocardial infarction, arrhythmia, heart failure after CHD diagnosis)
  • Funding: NIH

Key results

  • In the bioMe training/validation groups and holdout method groups, the model predicted the  CHD with an area below the curve of 0,95 (94 %  Sensitivity; 82 %  specificity) and 0.93 (90 %  Sensitivity; 88 %  Specificity).
  • In the external test group from the UK-_ Biobank predicted the model the  CHC with an area below the curve of 0,91 (84 %  Sensitivity; 83 %  Specificity).
  • The ISCAD score derived from the model included known CHD risk factors, pooled cohort equations and polygenic risk scores and ranged from 0 (lowest probability of outcome) to 1 (highest probability).
  • The risks of occurrence of the following results increased with the ISCAD score quartile: coronary artery stenosis, obstructive CHD, multi-vessel concerning  CHD and stenosis of the large coronary arteries.
  • The risk of death from any cause increased with the ISCAD score decile.The aHR was 1.0 for participants in decile 1 (prevalence of 0.2 %), 11 for participants in decile 6 (prevalence of 4.2 %) and 56 for participants in decile 10 (prevalence of 11 %).
  • The risk of recurrent myocardial infarction showed a similar increase.
  • Almost half (46 %) of participants with undiagnosed   CHD and an ISCAD score of ≥ 0.9 showed clinical signs of   CHC according to Guidelines.

Expert comment

  • In a Comment wrote Puneet Batra, Ph.D., Broad Institute of MIT &— Harvard and Verve Therapeutics, and Amit V.Khera, M.D., M.Sc., Brigham and Women’s Hospital: «Placing individuals on a spectrum of coronary artery disease that takes into account a variety of factors could allow for tailored interventions that better address the risks of coronary artery disease, unlike current scoring systems such as SYNTAX, which focus solely on coronary artery disease.»

Restrictions

  • The CHD participants were identified using diagnostic codes, which may have led to misclassifications.
  • Only a subset of participants underwent coronary angiography.
  • Data for cause-specific mortality were not available.
  • The generalizability to other populations is uncertain.

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