Risk stratification applied to CAST registry data: Combining 9 predictors

Timothy R Church, Morrison Hodges, James J. Bailey, Steven J Mongin

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Over 200, 000 people in the United States die of sudden cardiac death (SCD) every year. Although many of these deaths occur in asymptomatic individuals, the vast majority of deaths occur in people who are under care for existing coronary heart disease. Implantable cardioverter/defibrillators (ICDs) have been shown in several randomized trials to be effective in prolonging lives of those at high risk for sudden cardiac death, but the criteria used in these trials and the ACC/AHA consensus guidelines would cover only a minority of patients. Developing methods to assign risk to individual patients without prior SCD events could promote the use of this life-saving therapy in those with especially high risk. Given sufficient physiologically relevant measurements from electrocardiogram analysis, clinical assessment, and demographic status, multivariate statistical methods for predicting survival can be used to combine many predictors of risk and calculate the risk for an individual patient. A survival analysis using Cox regression on data from the Cardiac Arrhythmia Suppression Trial (CAST) illustrates this concept. Patient age, sex, ejection fraction, smoking history, and prior myocardial infarction history, along with the frequency of premature beats and the presence of runs of ventricular tachycardia on Holter monitoring and the time from the index myocardial infarction to the baseline Holter and to recruitment into CAST were combined in a multivariate predictor derived from the Cox regression; this predictor significantly outperforms the individual predictors. A proposed test based on this predictor would identify as positive 7% of the CAST registry, with an average risk of death among the positives of 47%; 20% of those dead at 2 years would be positive. With improved component measurements, this approach has the potential for significantly improving risk stratification for the prevention of SCD.

Original languageEnglish (US)
Pages (from-to)117-122
Number of pages6
JournalJournal of Electrocardiology
Issue number4
StatePublished - 2002

Bibliographical note

Funding Information:
From the *Division of Environmental & Occupational Health, University of Minnesota School of Public Health, Minneapolis, MN; †Research Group, Minneapolis Heart Institute Foundation, Minneapolis, MN; and ‡Center for Information Technology, National Institutes of Health, Bethesda, MD. This work was supported in part by a grant (#1803) to Dr. Hodges from the Minneapolis Heart Institute Foundation Reprint requests: Timothy R. Church, PhD, University of Minnesota School of Public Health, MMC 807, 420 Delaware St SE, Minneapolis, Minnesota 55455; e-mail: [email protected]. Copyright 2002, Elsevier Science (USA). All rights reserved. 0022-0736/02/350S-0017$35.00/0 doi:10.1054/jelc.2002.37168


  • Ejection fraction
  • Multivariate methods
  • Risk stratification
  • Sudden cardiac death


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