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Cabrera-Aguilera I, Ivern C, Badosa N, Marco E, Duran X, Mojón D, Vicente M, Llagostera M, Farré N, Ruíz-Bustillo S. Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation. J Clin Med 2022; 11:1910. [PMID: 35407518 PMCID: PMC8999920 DOI: 10.3390/jcm11071910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51−9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.
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Affiliation(s)
- Ignacio Cabrera-Aguilera
- Unit of Biophysics and Bioengineering, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08036 Barcelona, Spain;
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Department of Human Movement Sciences, School of Kinesiology, Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Consolació Ivern
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Neus Badosa
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Ester Marco
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar—Hospital de l’Esperança), 08003 Barcelona, Spain;
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Xavier Duran
- Methodological and Biostatistical Advisory Service, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), 08003 Barcelona, Spain;
| | - Diana Mojón
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Miren Vicente
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Marc Llagostera
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Nuria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Sonia Ruíz-Bustillo
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
- Department of Medicine, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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Predicting Long-Term Mortality in Patients with Angina across the Spectrum of Dysglycemia: A Machine Learning Approach. Diagnostics (Basel) 2021; 11:diagnostics11061060. [PMID: 34207578 PMCID: PMC8226455 DOI: 10.3390/diagnostics11061060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/21/2022] Open
Abstract
We aimed to develop and validate a model for predicting mortality in patients with angina across the spectrum of dysglycemia. A total of 1479 patients admitted for coronary angiography due to angina were enrolled. All-cause mortality served as the primary endpoint. The models were validated with five-fold cross validation to predict long-term mortality. The features selected by least absolute shrinkage and selection operator (LASSO) were age, heart rate, plasma glucose levels at 30 min and 120 min during an oral glucose tolerance test (OGTT), the use of angiotensin II receptor blockers, the use of diuretics, and smoking history. This best performing model was built using a random survival forest with selected features. It had a good discriminative ability (Harrell’s C-index: 0.829) and acceptable calibration (Brier score: 0.08) for predicting long-term mortality. Among patients with obstructive coronary artery disease confirmed by angiography, our model outperformed the Global Registry of Acute Coronary Events discharge score for mortality prediction (Harrell’s C-index: 0.829 vs. 0.739, p < 0.001). In conclusion, we developed a machine learning model to predict long-term mortality among patients with angina. With the integration of OGTT, the model could help to identify a high risk of mortality across the spectrum of dysglycemia.
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