对老年人的系统冠状动脉风险评估2:10年风险验证,临床效用和潜在改善
Yassin Belahnech1, Eduard Ródenas-Alesina1,2, Miguel Ángel Muñoz3,4,5
1Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
European journal of preventive cardiology
|December 10, 2024
概括
SCORE2-OP模型在低风险国家的老年人中显示出良好的10年心血管风险预测,在女性中表现更好. 添加膜化可能会提高准确性.
科学领域:
- 心脏病学 心脏病学
- 老年学是指老年学的学科.
- 流行病学 流行病学
背景情况:
- 欧洲系统性冠状动脉风险评估2老年人 (SCORE2-OP) 模型在外部验证研究中显示出可变的性能.
- 准确预测10年心血管 (CV) 风险对于老年人群的预防策略至关重要.
- 需要在代表性,低CV风险人群中评估SCORE2-OP模型.
研究的目的:
- 评估SCORE2-OP模型对10年心血管风险的预测性能和临床实用性,在来自心血管风险低的国家的老年人无偏的队列中.
- 探索是否有额外的临床或心声回声学特征可以提高模型的预测准确性.
主要方法:
- 一项前性队列研究包括791名65岁或以上的巴塞罗那初级保健人员,没有确定的心血管疾病.
- 该研究评估了SCORE2-OP模型的性能,使用Harrell's C-统计学来预测主要不良心血管事件和心血管死亡率的10年预测.
- 使用决策曲线分析来评估临床效用,并研究了膜化对风险预测的影响.
主要成果:
- SCORE2-OP模型表现出良好的歧视 (主要终点的C统计值为0.706) 和校准,女性的表现更好.
- 该模型低估了女性的风险,并系统地低估了包括心力衰竭住院治疗在内的更广泛终点的风险.
- 膜化被确定为一个显著的因素,改善了SCORE2-OP模型对初级和二级终点的预测性能.
结论:
- SCORE2-OP模型表现出显著的歧视性和优秀的校准性,用于从低心血管风险设置中预测老年人10年心血管风险,特别是在女性中.
- 将膜化纳入风险预测算法可以提高准确性,并可能减少过度处理.
- 对老年人群的风险评分进行进一步细化,考虑诸如膜化等因素是有必要的.
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