Author + information
- Received September 7, 2016
- Revision received February 28, 2017
- Accepted March 7, 2017
- Published online March 5, 2018.
- Bríain Ó Hartaigh, PhDa,
- Heidi Gransar, MSa,
- Tracy Callister, MDb,
- Leslee J. Shaw, PhDc,
- Joshua Schulman-Marcus, MDa,
- Wijnand J. Stuijfzand, MDa,
- Valentina Valenti, MDa,
- Iksung Cho, MDa,
- Jackie Szymonifka, MAa,
- Fay Y. Lin, MDa,
- Daniel S. Berman, MDd,
- Hyuk-Jae Chang, MDe and
- James K. Min, MDa,∗ ()
- aDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
- bTennessee Heart and Vascular Institute, Hendersonville, Nashville, Tennessee
- cDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- dDepartment of Imaging, Cedars Sinai Medical Center, Los Angeles, California
- eDivision of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
- ↵∗Address for correspondence:
Dr. James K. Min, Departments of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, 413 East 69th Street, Suite 108, New York, New York 10021.
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.
This study was supported in part by a grant from the National Institutes of Health (R01HL115150). This study was also funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Berman has received research funding from HeartFlow. Dr. Min has served as a consultant to HeartFlow; has ownership in MDDX and AutoPlaq; has served on the medical advisory board of Arineta; and has a research agreement with GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Matthew Budoff, MD, served as the Guest Editor for this paper.
- Received September 7, 2016.
- Revision received February 28, 2017.
- Accepted March 7, 2017.
- 2018 The Authors