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A new risk score from the Retrospective Analysis of maximal workload Predictors of survival in Ischemic heart Disease at 10 years: the RAPID-10 score
Session:
Posters (Sessão 6 - Écran 4) - Provas de Esforço e Reabilitação
Speaker:
Bruno Bragança
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Bruno Bragança; Inês G. Campos; Inês Oliveira; Isabel Cruz; Rafaela G. Lopes; Joel P. Monteiro; Conceição Queirós; Paulo Pinto; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Cardiac stress testing (CST) is valuable in the management of ischemic heart disease (IHD). The FIT Treadmill Score from the largest study of physical fitness - the Henry Ford Exercise Testing Project– is among the most accurate model in predicting survival. Recent data from our group showed that workload-indexed blood pressure (WPBR) is a strong and independent predictor of survival in IHD, a variable not included in the FIT score. Therefore, our purpose was to create a new score that includes WBPR and other maximal exercise variables and compare with the FIT score.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">The study comprised 713 patients with IHD that performed CST on treadmill between 2009-2010. The follow-up period was 10±2 years. WBPR (systolic blood pressure / (metabolic equivalent of task(met)-1)) and the FIT score were calculated at baseline as previously described <sup>1,2</sup>. Continuous variables were fitted using linear and nonlinear regressions. Time-to-event (death and major adverse cardiovascular events (MACE)) were correlated with baseline variables through logistic regression models. The new score was built using a backward stepwise regression of clinical and CST variables. Score accuracy was assessed with receiver operating characteristic (ROC) curves.</span> <span style="font-family:"Arial",sans-serif">Event-free survival analyses used Cox regression models.<strong> </strong>Data are: mean ± standard deviation; 95% confidence interval (CI) for hazard ratios (HR); significance level <em>p</em><0.05.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">Relevant baseline characteristics were: age 59±10 years, 87% male, 74% dyslipidemia, 65% hypertension, BMI 29±4 kg/m2, 31% diabetes, 16% chronic kidney disease, 45% smokers, 5% stroke, 76% myocardial infarction. During follow-up, 109 patients died (16%), 342 (49%) had MACE, 183 (26%) de novo heart failure (HF) and 100 (14%) myocardial infarction (MI). The final score (RAPID-10) combines four predictive variables of survival: binary WBPR (1 if ≥ 5.15 mmHg/met) and sex (1 if female); continuous maximal predicted heart rate (MPHR) and age-squared. The adjusted final model is: 4WPBR + 0.008age^2 + 20MPHR + 6sex. The median score was 11 points, ranging from -13 to 40 points. After adjusting for comorbidities and medication, each 10-point increase in RAPID-10 was associated with mortality (HR 1.85, CI 1.42-2.42, p<0.0001), MACE (HR 1.26, CI 1.42-2.42, p<0.0001), and HF (HR 1.4, CI 1.19-1.56, p<0.0001) but not MI (HR 0.91, CI 0.77-1.01, p=0.239). Discriminative power of RAPID-10 was good in ROC curves (AUC = 0.75), and slightly higher than FIT score (AUC = 0.73). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusions:</span></strong><span style="font-family:"Arial",sans-serif"> RAPID-10 score is a robust tool, with good discriminative power to predict 10-year survival in IHD patients. Further studies are needed to validate the model in other populations. </span></span></span></p> <ol> <li><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Hedman K, et al.,Eur J Prev Cardiol. 2020;27(9):978-987. 2- Ahmed HM, et al.,Mayo Clin Proc. 2015;90(3):346-55. </span></span></li> </ol>
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