简化冠状动脉疾病风险分层:开发和验证一个可比临床风险工具的基于问卷的替代方案
Michail Kokkorakis1, Pytrik Folkertsma2, Filippos Anagnostakis3
1Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
EBioMedicine
|December 26, 2024
概括
一个新的基于问卷的模型,QUES-CAD,有效地识别出患冠状动脉疾病 (CAD) 高风险的个体,而不需要物理测量或生物标志物. 这种具有成本效益的工具适用于全民查,特别是在资源有限的环境中.
科学领域:
- 心血管医学 心血管医学
- 公共卫生 公共卫生
- 生物统计学 生物统计学
背景情况:
- 冠状动脉疾病 (CAD) 是全球主要的死亡原因.
- 目前的风险分层模型需要昂贵的物理测量和生物标志物.
- 这些局限性阻碍了全民查,特别是在资源有限的地区.
研究的目的:
- 开发和验证一个成本效益的,基于问卷的风险分层模型,用于CAD.
- 为了使人口规模查10年CAD发病率.
- 克服现有的临床风险评估工具的局限性.
主要方法:
- 使用十个问卷变量开发了基于问卷评估的冠状动脉疾病估计 (QUES-CAD) 模型.
- 在英国生物银行使用Cox比例危险 (CoxPH) 和Cox梯度增强 (CoxGBT) 进行训练和验证的模型.
- 在生命线队列中对外部验证的QUES-CAD进行了验证,并将其性能与已建立的风险得分进行了比较 (例如,Framingham,SCORE2).
主要成果:
- 在外部验证中,QUES-CAD表现出与已建立的临床预测模型相似的性能 (男性的C指数:~0.69-0.70,女性:~0.76-0.77).
- 添加物理测量或生物标志物并没有显著改善QUES-CAD的预测性能.
- 部分日志概率比率测试和C指数比较证实了QUES-CAD的有效性.
结论:
- QUES-CAD提供了一种可靠的,低成本的方法来识别患有CAD高风险的个人.
- 该模型仅依赖于问卷数据,克服了传统方法的后勤和成本障碍.
- QUES-CAD促进了全人口的CAD风险评估,特别是在服务不足的地区.
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