risk stratification based on j-access risk models with myocardial perfusion imaging: risk versus outcomes of patients with chronic kidney disease

This study aimed to validate the accuracy of major-event risk models created in the multicenter j-access prognostic study in a new cohort of patients with chronic kidney disease (ckd). three multivariable j-access risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; model 2 with five variables including estimated glomerular filtration rate (egfr, continuous); and model 3 with categorical egfr. the validation data used three-year (3y) cohort of patients with ckd (n = 526, major events 11.2%). survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with egfr ≥ 15 ml/min/1.73 m2, p = .0087 (model 2). however, actual event rates were equally high across all risk groups of patients with egfr < 15 ml/min/1.73 m2. the j-access risk models can stratify patients with ckd and egfr ≥ 15 ml/min/1.73 m2, but patients with egfr < 15 ml/min/1.73 m2 are potentially at high risk regardless of estimated risk values.