Objectives The purpose of this study was to develop and validate a simple-to-use nomogram for prediction of 5-, 10-, and 15-year survival among asymptomatic adults.

Background Simple-to-use prognostication tools that incorporate robust methods such as coronary artery calcium scoring (CACS) for predicting near-, intermediate- and long-term mortality are warranted.

Methods In a consecutive series of 9,715 persons (mean age: 53.4 ± 10.5 years; 59.3% male) undergoing CACS, we developed a nomogram using Cox proportional hazards regression modeling that included: age, sex, smoking, hypertension, dyslipidemia, diabetes, family history of coronary artery disease, and CACS. We developed a prognostic index (PI) summing the number of risk points corresponding to weighted covariates, which was used to configure the nomogram. Validation of the nomogram was assessed by discrimination and calibration applied to a separate cohort of 7,824 adults who also underwent CACS.

Results A total of 936 and 294 deaths occurred in the derivation and validation sets at a median follow-up of 14.6 years (interquartile range: 13.7 to 15.5 years) and 9.4 years (interquartile range: 6.8 to 11.5 years), respectively. The developed model effectively predicted 5-, 10-, and 15-year probability of survival. The PI displayed high discrimination in the derivation and validation sets (C-index 0.74 and 0.76, respectively), indicating suitable external performance of our nomogram model. The predicted and actual estimates of survival in each dataset according to PI quartiles were similar (though not identical), demonstrating improved model calibration.

Conclusions A simple-to-use nomogram effectively predicts 5-, 10- and 15-year survival for asymptomatic adults undergoing screening for cardiac risk factors. This nomogram may be considered for use in clinical care.

目的本研究的目的是开发和验证一种易于使用的列线图，用于预测无症状成年人的5年，10年和15年生存期。

背景技术需要使用简单易用的预后工具，该工具结合了强大的方法，例如冠状动脉钙评分（CACS），可用于预测近期，中期和长期死亡率。

方法在连续的9,715人（平均年龄：53.4±10.5岁；男性59.3％）接受CACS的一系列研究中，我们使用Cox比例风险回归模型开发了诺模图，其中包括：年龄，性别，吸烟，高血压，血脂异常，糖尿病，家庭冠状动脉疾病的病史，以及CACS。我们开发了一个预后指数（PI），将与加权协变量相对应的风险点数量相加，用于配置列线图。通过对分别接受了CACS治疗的7,824名成年人的辨别和校准评估诺模图的有效性。

结果派生和验证组分别发生936和294例死亡，中位随访时间分别为14.6年（四分位数范围：13.7至15.5年）和9.4年（四分位数范围：6.8至11.5年）。所开发的模型有效地预测了5年，10年和15年的生存概率。PI在派生和验证集中显示出很高的辨别力（分别为C-index 0.74和0.76），这表明我们的列线图模型具有适当的外部性能。根据PI四分位数，每个数据集中的生存预测值和实际估计值相似（尽管不完全相同），表明模型校准得到了改善。

结论易于使用的列线图有效地预测了接受心脏危险因素筛查的无症状成年人的5年，10年和15年生存率。该诺模图可以考虑用于临床护理。