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CRAX: A simple cardiovascular risk assessment tool to predict risk of acute myocardial infarction or death

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Determining the risk of cardiovascular events is essential to optimize patient management.

Methods and Results

5842 individuals underwent SPECT myocardial perfusion imaging (MPI) with 4.4 ± 1.2 years of follow-up. Models (the CRAX tool) were derived to predict the cumulative risk of death and acute myocardial infarction (AMI) at 1, 3, and 5 years using clinical and MPI variables. Predictors of AMI and death included age, number of hospitalizations in the 3 years preceding MPI, and left ventricular ejection fraction (LVEF). Additional predictors of death were the use of pharmacological stress, and global stress total perfusion deficit (sTPD), while transient ischemic dilation (TID), and ischemic total perfusion deficit (iTPD) change were predictive of AMI. CRAX predictions were significantly (P < .001) more accurate than clinical variables or MPI results alone, resulting in a significant net reclassification improvement (NRI, 7.5% for AMI, 14.5% death) compared to clinical variables alone. Accuracy for predicting major adverse cardiac events (MACE, comprising all-cause death, AMI, unstable angina, late revascularization) was comparable to that of AMI or death.

Conclusions

CRAX is a risk assessment tool that predicts the risk of AMI, death, or MACE, and improves prediction compared to clinical variables or MPI results alone.

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Abbreviations

CRAX:

Cardiovascular risk assessment

SPECT:

Single-photon emission computed tomography

MPI:

Myocardial perfusion imaging

AMI:

Acute myocardial infarction

MACE:

Major adverse cardiac event

LVEF:

Left ventricular ejection fraction

TID:

Transient ischemic dilatation

NRI:

Net reclassification improvement

iTPD:

Ischemic total perfusion defect

sTPD:

Stress total perfusion defect

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2012/2013 -18). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers are intended or should be inferred.

Disclosures

P. Martineau, W. Leslie, and A. Goertzen declare that they have no conflict of interest. P. Slomka participates in software royalties at Cedars-Sinai Medical Center for the licensing of the software for myocardial perfusion quantification.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University of Manitoba, 820 Sherbrook Street GC321, Winnipeg, MB, R3A 1R9, Canada

    Patrick Martineau MD, PhD, Andrew Goertzen PhD & William D. Leslie MD, MSc

  2. Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Patrick Martineau MD, PhD

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Piotr Slomka PhD

  4. Department of Internal Medicine, University of Manitoba, C5121-409 Tache Ave, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie MD, MSc

Authors
  1. Patrick Martineau MD, PhD
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  4. William D. Leslie MD, MSc
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Correspondence to William D. Leslie MD, MSc.

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Funding

This research was supported in part by the National Institutes of Health (NIH) grant R01 HL089765 (PS).

Electronic supplementary material

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12350_2018_1556_MOESM1_ESM.xlsx

Supplementary material 1 The CRAX tool predicts risk of AMI or death more accurately than clinical or imaging variables alone (XLSX 17 kb)

Supplementary material 2 (PPTX 387 kb)

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Martineau, P., Slomka, P., Goertzen, A. et al. CRAX: A simple cardiovascular risk assessment tool to predict risk of acute myocardial infarction or death. J. Nucl. Cardiol. 27, 2365–2374 (2020). https://doi.org/10.1007/s12350-018-01556-0

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  • DOI: https://doi.org/10.1007/s12350-018-01556-0

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