The REVEAL registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension

Raymond L. Benza, Mardi Gomberg-Maitland, Dave P. Miller, Adaani Frost, Robert P. Frantz, Aimee J. Foreman, David B. Badesch, Michael D. McGoon

Research output: Contribution to journalArticle

264 Scopus citations

Abstract

Background: In pulmonary arterial hypertension (PAH), survival predictions can be important for optimization of therapeutic strategies. The present study aimed to validate a quantitative algorithm for predicting survival derived from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry) and develop a simplified calculator for everyday clinical use. Methods: Prospectively collected data from patients with newly diagnosed (< 3 months) World Health Organization group I pulmonary hypertension enrolled in the REVEAL Registry were used to validate a predictive algorithm for 1-year survival. Model calibration was evaluated by comparing algorithm-predicted survival with observed Kaplan-Meier estimates for the overall validation cohort and for five risk groups. Similarly, the risk discriminators for the simplified calculator were compared with those of the quantitative algorithm. Results: The validation cohort comprised 504 individuals with mean ± SD 6-min walk distance 308 ± 128 m, and 61.5% were functional class III. The proportion of patients surviving 1 year fell within the range predicted by the model (95.1%, 91.5%, 84.6%, 76.3%, and 58.2%, respectively) among patients in the low (predicted survival ≥ 95%), average (90% to < 95%), moderate (85% to < 90%), high (70% to < 85%), and very high (< 70%) risk strata. Predicted and observed 1-year survival were similar across risk stratum, and the c-index indicated good discrimination for both the full equation (0.726) and the simplified risk calculator (0.724). Conclusions: The REVEAL Registry predictive algorithm and simplified risk score calculator are well calibrated and demonstrate good discriminatory ability in patients with newly or previously diagnosed PAH. Trial registry: ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.

Original languageEnglish (US)
Pages (from-to)354-362
Number of pages9
JournalChest
Volume141
Issue number2
DOIs
StatePublished - Feb 2012

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Benza, R. L., Gomberg-Maitland, M., Miller, D. P., Frost, A., Frantz, R. P., Foreman, A. J., Badesch, D. B., & McGoon, M. D. (2012). The REVEAL registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest, 141(2), 354-362. https://doi.org/10.1378/chest.11-0676