SUPPLEMENTAL MATERIAL. Supplemental Methods. Duke CAD Index

Transcription

1 SUPPLEMENTAL MATERIAL Supplemental Methods Duke CAD Index The Duke CAD index, originally developed by David F. Kong, is an angiographic score that hierarchically assigns prognostic weights (0-100) based on the anatomic location, stenotic severity and extent of coronary artery lesions in an individual patient. The index reliably predicted 5-year mortality in an analysis of 3800 patients with native coronary artery disease 1. The model was subsequently modified to predict long-term mortality among patients with coronary artery bypass graft disease 2. To adjust for individual differences in the severity and extent of coronary artery disease, we used the latest iteration of this well-validated composite measure of angiographic disease burden as a covariate in all our multivariable models. As seen in the list of retained model covariates in the response to comment 1), the Duke CAD index was retained as a significant independent predictor in all four main effects models in our study. Duke CAD Index: Angiographic Scoring System Adapted from Bart et al 1.

2 Spline Transformations for Non-linear Continuous Variables: The following variables were each transformed to two linear splines since the linearity assumptions were not satisfied: SBP-right truncated at 125 mm Hg, HR-left truncated at 65 min -1, BMI-right truncated at 30 kg m -2, GFR-right truncated at 90 ml min -1, For each of these variables, the two linear splines were simplified to one piece if the other piece was not significant at the 0.05 level. Supplemental Tables Variable Retention in Multivariable Models: The following tables list the variables retained in the 4 main effects models: Long-term Propensity Hazards Model Variable Parameter Dƒ Estimate SE Chi- Square P value HR 95% CI STEMI vs NSTEMI Age, per decade < increase SBP, mm Hg* < Heart rate, min < BMI, kg m < Charlson index < Duke CAD index < GFR, ml min < Black race Hyperlipidemia Smoking Prior HF < Prior CABG < Prior PCI Hypertension Dƒ =degrees of freedom, SE=standard error, HR=hazard ratio, CI=confidence interval,sbp=systolic blood pressure, BMI=body mass index, CAD= coronary artery disease, GFR=glomerular filtration rate, HF=heart failure, CABG=coronary artery bypass grafting, PCI=percutaneous coronary intervention.* per 10 mm Hg increase up to 125

3 mm Hg, per 5 unit increase above 65 beats min -1, per unit increase up to 30 kg m -2, per 10 ml min -1 increase up to 90 ml min -1.

4 Piecewise Proportional Hazards Model Variable STEMI vs. NSTEMI (0-2 months) STEMI vs. NSTEMI (2mo-8 years) Age per decade increase, years Dƒ Parameter Estimate SE Chi- Square P value HR 95% CI < < < SBP, mm Hg < HR, min < BMI < Charlson index < Duke CAD index < GFR, ml min < Black race Smoking Prior HF < Prior CABG < Prior PCI Hypertension

5 Early vs. Late/No Revascularization Model: STEMI Early vs. late/no revascularization Age per decade increase, years Dƒ Parameter Estimate Chi- Square P Value HR 95% CI SBP, mm Hg HR min BMI, kg m Charlson Index Duke CAD Index GFR, ml min Black race Hyperlipidemia Smoking Prior HF Prior CABG Prior PCI Hypertension

6 Variable Early vs. Late/No Revascularization Model: NSTEMI Early vs. late/no revascularization Age per decade increase, years Dƒ Parameter Estimate SE Chi- Square P value HR 95% CI < SBP, mm Hg HR min < BMI, kg m < Charlson index < Duke CAD index < GFR, ml min < Black race Hyperlipidemia Smoking Prior HF < Prior CABG < Prior PCI Hypertension

7 Sex-specific Data: Baseline Characteristics: STEMI (n=1974) NSTEMI (n=2413) P value Women (n=617) Men (n=1357) Women (n=819) Men (n=1564) Demographics <0.001 Age 65 (54,75 ) 57 (50,66 ) 68 (58,77 ) 63 (54,72 ) <0.001 African -American <0.001 Medical History <0.001 Diabetes Mellitus <0.001 Prior heart failure <0.001 Prior MI <0.001 Prior PCI <0.001 Prior CABG <0.001 Presentation Features <0.001 GFR (ml/min) 69.9 (53.1,90.1) 82.2(67.9,96.6) 65.6(46.2,84.6) 76.8(58.7,92.4) <0.001 Killip class II-IV, <0.001 % Charlson index* 0.5 (0, 1) 0.4 (0, 1) 0.9 (0, 1) 0.8 (0, 1) <0.001 Duke CAD severity 43 (31, 65) 43 (31,71) 52 (31, 77) 65 (37, 91) <0.001 index Ejection fraction, 48.9 (38.5, 58.1) 49.1 (40.3, 57.5) 52.9 (41.8, 51.2 (38.9, <0.001 % 30-day revascularization 63.0) 60.2) <0.001

8 Long-Term Cumulative Survival Plots Stratified by Sex: K-M Survival Curves: STEMI vs. NSTEMI Stratified by Sex Years ST: Female NST: Female ST: Male NST: Male

9 References: 1. Bart BA, Shaw LK, McCants CB, Jr., Fortin DF, Lee KL, Califf RM, O'Connor CM. Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. J Am Coll Cardiol. 1997;30: Liao L, Kong DF, Shaw LK, Sketch MH, Jr., Milano CA, Lee KL, Mark DB. A new anatomic score for prognosis after cardiac catheterization in patients with previous bypass surgery. J Am Coll Cardiol. 2005;46: