Article Text
Abstract
Objective To characterise the long-term prognosis of patients with stable coronary artery heart disease by means of ‘standard predictors’ defined as demographic, clinical and biochemical quantities routinely available in general practices and ascertained at an interview not prompted by renewed cardiac complaints.
Methods This is an observational study based on data from 2199 Copenhagen placebo patients from the ‘clarithromycin for patients with stable coronary heart disease’ trial of patients with stable coronary heart disease. In the trial, we compared the effects of 14 days of clarithromycin treatment versus placebo. The predictors were based on the interview forms and blood samples collected at entry, along with demographic information from hospital files.
We studied ‘standard predictors’ of a composite outcome (myocardial infarction, unstable angina, cerebrovascular disease or all-cause death) and of all-cause death. Using Cox regression, we compared predictions of status at 3, 6 and 9 years without and with the use of ‘standard predictors’ and used receiver operating characteristic statistic.
Results Few ‘standard predictors’ were associated (p<0.01) with the composite outcome or with all-cause death. When no ‘standard predictors’ were included, 63.2% of the model-based predictions of the composite outcome and 79.9% of death predictions were correct. Including all ‘standard predictors’ in the model increased the figures to 68.4% and 83.4%, respectively. C indices were low, except when all-cause death was assessed as a single outcome where C was 0.79.
Conclusion ‘Standard predictors’ routinely available in general practices contribute only modestly to risk assessment in consecutively sampled patients with stable coronary heart disease as ascertained at a contact not prompted by renewed cardiac complaints. Novel biomarkers may improve the assessment.
Trial registration number NCT00121550.
- CLARICOR
- cardiovascular disease
- ischaemic heart disease
- predictors
- mortality.
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Footnotes
Contributors PW, JH, JCJ and CG contributed substantially to the concept and design and drafted the manuscript. PW and JH conducted the statistical analyses. AL and JÄ conducted the analysis of lipids and creatinine. All authors revised the manuscript critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in assuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This study was funded by the Copenhagen Trial Unit, Centre for Clinical Intervention Research; original funders of the CLARICOR trial; and the Swedish Research Council, Swedish Heart-Lung Foundation; Thuréus Foundation; Marianne and Marcus Wallenberg Foundation, Dalarna University; and Uppsala University.
Competing interests None declared.
Patient consent Not required.
Ethics approval Danish Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data statement All pertinent anonymised data will be uploaded at ZENODO (http://zenodo.org/) when the individual manuscripts have been published.