Atherosclerosis ( IF 5.3 ) Pub Date : 2021-07-11 , DOI: 10.1016/j.atherosclerosis.2021.07.003 Pishoy Gouda 1 , Chinthanie Ramasundarahettige 2 , Sonia Anand 2 , Eva Muhlhoffer 3 , Scott Berkowitz 3 , Keith Aa Fox 4 , John Eikelboom 2 , Robert Welsh 1
Background and aims
Patients with coronary artery disease (CAD) who also have peripheral artery disease (PAD) are at high risk of subsequent cardiovascular events and mortality. Despite this, PAD in patients with CAD often remain undiagnosed. The objective of this analysis was to assess clinical factors that predict the presence of PAD in patient with documented CAD who also have PAD.
Methods
In a post hoc analysis of patients with CAD in the COMPASS trial, we developed separate prediction models for symptomatic lower extremity PAD and documented carotid artery disease (Model 1), asymptomatic lower extremity PAD defined as ABI <0.9 (Model 2) and for any PAD (symptomatic or asymptomatic; Model 3). Using logistic regression models, candidate variables were chosen to predict the presence of PAD. Overall model performance was evaluated for discrimination and calibration using the concordance statistic and Hosmer and Lemeshow Goodness-of-fit chi-square respectively. The final model was validated by bootstrapping.
Results
Of 23,402 participants, 3484 (14.9%) had a history of symptomatic PAD or carotid artery disease (Model 1), 1422 (5.7%) participants had asymptomatic PAD (Model 2) and 4906 (20.6%) had any PAD (Model 3). Model 1 demonstrated a C-statistic of 0.667 and goodness-of-fit p-value of 0.859. Model 2 demonstrated a C-statistic of 0.626 and goodness-of-fit p-value of 0.250. Model 3 demonstrated a C-statistic of 0.646 and goodness-of-fit p-value of 0.240.
Conclusion
Routinely available clinical information are only marginally useful to identify patients CAD and concomitant PAD.
中文翻译:
冠状动脉疾病患者与外周动脉疾病相关的临床因素:COMPASS 试验的事后分析
背景和目标
冠状动脉疾病 (CAD) 患者同时患有外周动脉疾病 (PAD),随后发生心血管事件和死亡的风险很高。尽管如此,CAD 患者的 PAD 常常未被确诊。该分析的目的是评估预测患有 PAD 的 CAD 患者是否存在 PAD 的临床因素。
方法
在 COMPASS 试验中对 CAD 患者进行的事后分析中,我们针对有症状的下肢 PAD 和记录的颈动脉疾病(模型 1)、定义为 ABI <0.9(模型 2)的无症状下肢 PAD 以及任何PAD(有症状或无症状;模型 3)。使用逻辑回归模型,选择候选变量来预测 PAD 的存在。分别使用一致性统计量和 Hosmer 和 Lemeshow 拟合优度卡方来评估整体模型性能的辨别和校准。最终模型通过自举验证。
结果
在 23,402 名参与者中,3484 名(14.9%)有症状性 PAD 或颈动脉疾病史(模型 1),1422 名(5.7%)参与者有无症状性 PAD(模型 2)和 4906 名(20.6%)有任何 PAD(模型 3) . 模型 1 展示了 0.667 的 C 统计量和 0.859 的拟合优度 p 值。模型 2 展示了 0.626 的 C 统计量和 0.250 的拟合优度 p 值。模型 3 展示了 0.646 的 C 统计量和 0.240 的拟合优度 p 值。
结论
常规可用的临床信息对于识别患者 CAD 和伴随的 PAD 仅略有帮助。