JACC Adv. 2026 Jan 2;5(2):102508. doi: 10.1016/j.jacadv.2025.102508. Online ahead of print.
ABSTRACT
BACKGROUND: Secondary Manifestations of Arterial Disease (SMART) risk score-based projection of risk for cardiovascular (CV) events can help devise risk mitigation strategies.
OBJECTIVES: The objective of the study was to analyze the use of the SMART polyvascular disease score to compute the risk for major adverse CV events (MACE) in U.S.
METHODS: We accessed the Baylor Scott & White EPIC informatics and data warehouse to identify patients at their first outpatient cardiology evaluation between April 2014 and October 2023 to estimate up to 10-year risk of MACE, a composite of all-cause death, ischemic stroke, and nonfatal myocardial infarction (MI). Cox regression, accelerated failure time model, and survival analyses were used to develop and validate the SMART risk score.
RESULTS: The study population of 259,250 patients (mean age 60.9 ± 15.2 years, 48.6% females) were divided into development (60%) and test (40%) cohorts; median follow-up 2.1 years (IQR: 0.54-4.4). The SMART risk score allowed accurate estimation of MACE. Patients in low (<10%), moderate (10%-<20%), high (20%-<30%), and very high (≥30%) SMART risk score groups had observed MACE events rates of 2.9%, 15.0%, 24.5%, and 56.5%, respectively, in the test cohort (P < 0.0001 for all intergroup comparisons). Most MACE events were all-cause death, with nonfatal myocardial infarction and stroke also being high, in the very high-risk group. The SMART score outperformed an established risk prediction model (TIMI Risk Score for Secondary Prevention [TRS2°P]; C-statistic = 0.811) in the test cohort.
CONCLUSIONS: The SMART polyvascular disease risk score can provide accurate estimation of up to 10-year risk of CV events and could be potentially leveraged to develop individualized risk mitigation strategies.
PMID:41483543 | DOI:10.1016/j.jacadv.2025.102508