Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring

Bríain Ó Hartaigh, Heidi Gransar, Tracy Callister, Leslee J. Shaw, Joshua Schulman-Marcus, Wijnand J. Stuijfzand, Valentina Valenti, Iksung Cho, Jackie Szymonifka, Fay Y. Lin, Daniel S. Berman, Hyuk Jae Chang, James K. Min

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)450-458
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume11
Issue number3
DOIs
Publication statusPublished - 2018 Mar

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Nomograms
Coronary Vessels
Calcium
Survival
Calibration
Dyslipidemias
Coronary Artery Disease
Smoking
Hypertension
Mortality

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Ó Hartaigh, Bríain ; Gransar, Heidi ; Callister, Tracy ; Shaw, Leslee J. ; Schulman-Marcus, Joshua ; Stuijfzand, Wijnand J. ; Valenti, Valentina ; Cho, Iksung ; Szymonifka, Jackie ; Lin, Fay Y. ; Berman, Daniel S. ; Chang, Hyuk Jae ; Min, James K. / Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring. In: JACC: Cardiovascular Imaging. 2018 ; Vol. 11, No. 3. pp. 450-458.
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title = "Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring",
abstract = "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.",
author = "{{\'O} Hartaigh}, Br{\'i}ain and Heidi Gransar and Tracy Callister and Shaw, {Leslee J.} and Joshua Schulman-Marcus and Stuijfzand, {Wijnand J.} and Valentina Valenti and Iksung Cho and Jackie Szymonifka and Lin, {Fay Y.} and Berman, {Daniel S.} and Chang, {Hyuk Jae} and Min, {James K.}",
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Ó Hartaigh, B, Gransar, H, Callister, T, Shaw, LJ, Schulman-Marcus, J, Stuijfzand, WJ, Valenti, V, Cho, I, Szymonifka, J, Lin, FY, Berman, DS, Chang, HJ & Min, JK 2018, 'Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring', JACC: Cardiovascular Imaging, vol. 11, no. 3, pp. 450-458. https://doi.org/10.1016/j.jcmg.2017.03.018

Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring. / Ó Hartaigh, Bríain; Gransar, Heidi; Callister, Tracy; Shaw, Leslee J.; Schulman-Marcus, Joshua; Stuijfzand, Wijnand J.; Valenti, Valentina; Cho, Iksung; Szymonifka, Jackie; Lin, Fay Y.; Berman, Daniel S.; Chang, Hyuk Jae; Min, James K.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 3, 03.2018, p. 450-458.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring

AU - Ó Hartaigh, Bríain

AU - Gransar, Heidi

AU - Callister, Tracy

AU - Shaw, Leslee J.

AU - Schulman-Marcus, Joshua

AU - Stuijfzand, Wijnand J.

AU - Valenti, Valentina

AU - Cho, Iksung

AU - Szymonifka, Jackie

AU - Lin, Fay Y.

AU - Berman, Daniel S.

AU - Chang, Hyuk Jae

AU - Min, James K.

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

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U2 - 10.1016/j.jcmg.2017.03.018

DO - 10.1016/j.jcmg.2017.03.018

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