Risk of Cardiovascular Events Using the SMART Polyvascular Disease Risk Score

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 (