TY - JOUR
T1 - A novel risk score to the prediction of 10-year risk for coronary artery disease among the elderly in Beijing based on competing risk model
AU - Liu, Long
AU - Tang, Zhe
AU - Li, Xia
AU - Luo, Yanxia
AU - Guo, Jin
AU - Li, Haibin
AU - Liu, Xiangtong
AU - Tao, Lixin
AU - Yan, Aoshuang
AU - Guo, Xiuhua
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t=10 years were 0.841 [95% confidence interval (95% CI): 0.806-0.877], 0.804 (95% CI: 0.768- 0.839) in Fine and Gray model, 0.784 (95% CI: 0.738-0.830), 0.733 (95% CI: 0.6920.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese adults over 55 years old.
AB - The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t=10 years were 0.841 [95% confidence interval (95% CI): 0.806-0.877], 0.804 (95% CI: 0.768- 0.839) in Fine and Gray model, 0.784 (95% CI: 0.738-0.830), 0.733 (95% CI: 0.6920.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese adults over 55 years old.
UR - http://www.scopus.com/inward/record.url?scp=84962019715&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000002997
DO - 10.1097/MD.0000000000002997
M3 - Article
C2 - 26986112
AN - SCOPUS:84962019715
SN - 0025-7974
VL - 95
SP - e2997
JO - Medicine (United States)
JF - Medicine (United States)
IS - 11
M1 - e2997
ER -