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Ann Thorac Surg 2003;75:1820-1825
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

A simple model to predict coronary disease in patients undergoing operation for mitral regurgitation

^a Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
^b Medical Research Council Biostatistics Unit, Cambridge, United Kingdom
^c Division of Cardiology, Department of Internal Medicine, University of Witwatersrand and Johannesburg Hospital, Johannesburg, South Africa

Accepted for publication January 16, 2003.

^* Address reprint requests to Mr Lim, Department of Cardiothoracic Surgery, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
e-mail: ericlim2{at}hotmail.com

BACKGROUND: Coexistent coronary disease can be identified in a third of patients with mitral valve disease. This study aims to evaluate candidate selection strategy using risk factor identification and logistic regression and to develop an additive model for the prediction of coexistent coronary disease.

METHODS: The sample is a consecutive series of patients who had mitral repair from 1987 to 1999. Sensitivities and specificities were calculated for each risk factor. Variables for prediction of coronary disease were entered into a univariate analysis, and predictors were entered into a forward and backward stepwise multivariate logistic regression model to form a predictive score. An additive model was derived from transformation of the logistic model. Receiver operating characteristic curves were used to compare discrimination and precision quantified by the Hosmer-Lemeshow statistic.

RESULTS: The American Heart Association and American College of Cardiology risk factor identification selection criteria for the 359 patients who had screening coronary angiography yielded 100% sensitivity and 1% specificity. Risk prediction with our logistic model produced a receiver operating characteristic curve area of 0.91 and Hosmer-Lemeshow score of 3.4 (p = 0.9). Similar discriminating ability for our patients was achieved by the Cleveland Clinic logistic model (receiver operator characteristic curve area of 0.79; Hosmer-Lemeshow score of 12; p = 0.1). Our five-item additive model produced receiver operating characteristic curve area of 0.91 and Hosmer-Lemeshow score of 3.81 (p = 0.80).

CONCLUSIONS: Simple risk factor identification has excellent sensitivity but is limited by specificity. Logistic regression modeling is an accurate risk prediction method but is difficult to apply at the bedside. Simplicity and accuracy may be achieved by the logistic regression-derived simple additive model.

This article has been cited by other articles:

				E. Lim, A. Ali, Z. Khalpey, H. Ashrafian, C. Jackson, Z. Ali, T. Chamageorgakis, F. Wells, J. Pepper, A. DeSouza, et al. A validated simple model to predict coexistent coronary disease in patients undergoing mitral valve surgery J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1318 - 1321. [Abstract] [Full Text] [PDF]