Annals of vascular surgery · 2026
External Validation of the BEST-CLI Major Adverse Cardiac Risk Calculator in the Vascular Quality Initiative and Vascular Implant Surveillance and Interventional Outcomes Network.
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Patel Nathan T P, Mouradian Gregory, Ferris Mead B, Zheng Xinyan, Mao Jialin, Farber Alik, Bertges Daniel J
Аннотация
BACKGROUND: To perform external validation of the 1-year major adverse cardiac event (MACE) model derived from the Best Endovascular versus Best Surgical Therapy in patients with critical limb ischemia (BEST-CLI) cohort on the real-world database from the vascular quality initiative (VQI) and Vascular Implant Surveillance and Interventional Outcomes Network (VISION).
METHODS: We applied the BEST-CLI MACE model to compare the observed versus expected rate of 1-year MACE defined as death, myocardial infarction (MI), and cerebrovascular accident (CVA) in patients within the VQI-VISION Peripheral Vascular Intervention and Infrainguinal Registries (2016-2019). Kaplan-Meier analysis was performed to calculate the observed 1-year rate of MACE. Model calibration and discrimination were assessed with Cox calibration slope and intercept with Harrel's C-index.
RESULTS: We identified 19,144 eligible patients (endovascular n=14,878, 77.7%; open n=4,266, 22.3%) from the VQI-VISION database. Kaplan-Meier estimated 1-year mortality was 25.3% (95% confidence interval [CI] 24.6%-25.9%), MI 10.3% (95% CI 9.8%-10.8%), and CVA 4.9% (95% CI 4.6%-5.3%), with a composite MACE of 32.6% (95% CI 31.9%-33.3%). BEST-CLI MACE scores ranged between -4 and 23 (median patient score = 9, interquartile range: 5-13). The mean deviation between the observed 1-year MACE from the VQI-VISION compared to BEST-CLI estimated MACE was 8.6% (95% CI 8.5%-8.7%) higher. The model calibration slope was 0.54, intercept was 0.31, and discrimination C-index was 0.62.
CONCLUSION: This external validation of the BEST-CLI 1-year MACE scoring system suggests modest predictive ability in real-world vascular practice with the model underestimating 1-year MACE on average by 8.6%.
METHODS: We applied the BEST-CLI MACE model to compare the observed versus expected rate of 1-year MACE defined as death, myocardial infarction (MI), and cerebrovascular accident (CVA) in patients within the VQI-VISION Peripheral Vascular Intervention and Infrainguinal Registries (2016-2019). Kaplan-Meier analysis was performed to calculate the observed 1-year rate of MACE. Model calibration and discrimination were assessed with Cox calibration slope and intercept with Harrel's C-index.
RESULTS: We identified 19,144 eligible patients (endovascular n=14,878, 77.7%; open n=4,266, 22.3%) from the VQI-VISION database. Kaplan-Meier estimated 1-year mortality was 25.3% (95% confidence interval [CI] 24.6%-25.9%), MI 10.3% (95% CI 9.8%-10.8%), and CVA 4.9% (95% CI 4.6%-5.3%), with a composite MACE of 32.6% (95% CI 31.9%-33.3%). BEST-CLI MACE scores ranged between -4 and 23 (median patient score = 9, interquartile range: 5-13). The mean deviation between the observed 1-year MACE from the VQI-VISION compared to BEST-CLI estimated MACE was 8.6% (95% CI 8.5%-8.7%) higher. The model calibration slope was 0.54, intercept was 0.31, and discrimination C-index was 0.62.
CONCLUSION: This external validation of the BEST-CLI 1-year MACE scoring system suggests modest predictive ability in real-world vascular practice with the model underestimating 1-year MACE on average by 8.6%.