A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis - PubMed (original) (raw)

Randomized Controlled Trial

doi: 10.1002/acr.20433.

Andrew Judge, Rajbir Batra, Oliver Flossmann, Lorraine Harper, Peter Höglund, M Kassim Javaid, David Jayne, Chetan Mukhtyar, Kerstin Westman, John C Davis Jr, Gary S Hoffman, W Joseph McCune, Peter A Merkel, E William St Clair, Philip Seo, Robert Spiera, John H Stone, Raashid Luqmani

Affiliations

Randomized Controlled Trial

A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis

Ravi Suppiah et al. Arthritis Care Res (Hoboken). 2011 Apr.

Abstract

Objective: To create a prognostic tool to quantify the 5-year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without premorbid CV disease.

Methods: We reviewed CV outcomes during the long-term followup of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as CV death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort.

Results: Seventy-four (13.8%) of 535 patients with 5 years of followup from the EUVAS trials had at least 1 CV event: 33 (11.7%) of 281 WG versus 41 (16.1%) of 254 MPA. The independent determinants of CV outcomes were older age (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.11-1.90), diastolic hypertension (OR 1.97, 95% CI 0.98-3.95), and positive proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA) status (OR 0.39, 95% CI 0.20-0.74). The model was validated using the WGET cohort (area under the receiver operating characteristic curve of 0.80).

Conclusion: Within 5 years of diagnosis of WG or MPA, 14% of patients will have a CV event. We have constructed and validated a tool to quantify the risk of a CV event based on age, diastolic hypertension, and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with a reduced CV risk compared to myeloperoxidase ANCA or negative ANCA status.

Copyright © 2011 by the American College of Rheumatology.

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Conflict of interest statement

Competing interests: none

Figures

Figure 1

Figure 1

Final model to predict the risk of a cardiovascular event in the first 5 years from diagnosis with microscopic polyangiitis or Wegener’s granulomatosis Five year CV risk is shown as: green = low risk (<10%), orange = moderate risk (10–20%), Red = high risk (>20%).

Figure 2

Figure 2

Receiver operating characteristic curves comparing our new disease specific model with the traditional points based Cox-Framingham model

Figure 3

Figure 3

Conditional inference tree showing approximate risk of a cardiovascular event within 5 years based on baseline clinical features % shown is the risk of a cardiovascular event within 5 years of diagnosis of Wegener’s granulomatosis or microscopic polyangiitis. N=Cardiovascular events/number of individuals in Group

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