Validation and comparison of 28 risk prediction models for coronary artery disease

Chris Lenselink, Daan Ties, Rick Pleijhuis, Pim van der Harst

Research output: Contribution to journalArticleAcademicpeer-review


Aims: Risk prediction models (RPMs) for coronary artery disease (CAD), using variables to calculate CAD risk, are potentially valuable tools in prevention strategies. However, their use in the clinical practice is limited by a lack of poor model description, external validation, and head-to-head comparisons. Methods and results: CAD RPMs were identified through Tufts PACE CPM Registry and a systematic PubMed search. Every RPM was externally validated in the three cohorts (the UK Biobank, LifeLines, and PREVEND studies) for the primary endpoint myocardial infarction (MI) and secondary endpoint CAD, consisting of MI, percutaneous coronary intervention, and coronary artery bypass grafting. Model discrimination (C-index), calibration (intercept and regression slope), and accuracy (Brier score) were assessed and compared head-to-head between RPMs. Linear regression analysis was performed to evaluate predictive factors to estimate calibration ability of an RPM. Eleven articles containing 28 CAD RPMs were included. No single best-performing RPM could be identified across all cohorts and outcomes. Most RPMs yielded fair discrimination ability: mean C-index of RPMs was 0.706 ± 0.049, 0.778 ± 0.097, and 0.729 ± 0.074 (P < 0.01) for prediction of MI in UK Biobank, LifeLines, and PREVEND, respectively. Endpoint incidence in the original development cohorts was identified as a significant predictor for external validation performance. Conclusion: Performance of CAD RPMs was comparable upon validation in three large cohorts, based on which no specific RPM can be recommended for predicting CAD risk.

Original languageEnglish
Pages (from-to)666-674
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number4
Early online date30 Jul 2021
Publication statusPublished - 30 Mar 2022
Externally publishedYes


  • Coronary Artery Bypass
  • Coronary Artery Disease/diagnosis
  • Coronary artery disease
  • Humans
  • Myocardial Infarction/diagnosis
  • Myocardial ischaemia
  • Percutaneous Coronary Intervention
  • Predictive Value of Tests
  • Preventive medicine
  • Risk Assessment
  • Risk Factors
  • Risk assessment
  • Risk prediction models


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