比利时 SCORE 风险图表对心血管死亡率的预测能力。

Predictive ability of the SCORE Belgium risk chart for cardiovascular mortality.

机构信息

Department of Public Health, Ghent University, Gent, Belgium.

出版信息

Int J Cardiol. 2010 Sep 3;143(3):385-90. doi: 10.1016/j.ijcard.2009.03.101. Epub 2009 Apr 22.

DOI:10.1016/j.ijcard.2009.03.101

PMID:19386372

Abstract

BACKGROUND

The identification of persons at high cardiovascular risk is of primary importance in the context of cardiovascular prevention. Accuracy and precision of risk assessment are essential properties. We developed a calibrated SCORE risk chart (Systematic COronary Risk Evaluation) for calculating the absolute 10-year probability of developing a fatal cardiovascular event, adapted to national mortality statistics and risk factor distributions in Belgium and critically evaluated its predictive accuracy.

METHODS

Our SCORE Belgium risk chart was validated using data from 6212 non-diabetic men and women free of CHD participating in a prospective cohort study carried out in the eighties (Belgian Interuniversity Research on Nutrition and Health). Agreement between numbers of predicted and observed CVD deaths across the entire spread of risk was studied using chi-square and Hosmer-Lemeshow statistics. Discriminatory power of risk estimates was evaluated according to Harrell's c-statistic.

RESULTS

During the period of 10 years, 274 CVD deaths were observed while the recalibrated risk chart predicted 263 events. The SCORE Belgium risk chart showed very good accuracy over the complete range of predicted risk (Hosmer-Lemeshow: P=0.14). ROC analysis revealed excellent discriminatory power in labelling future cases of fatal cardiovascular disease with a c-statistic of 0.86. The 5% threshold for the probability of 10-year cardiovascular death yielded an optimal balance of sensitivity and specificity.

CONCLUSIONS

The SCORE Belgium risk chart proves to be well suited as an accurate and precise estimation tool for the assessment of cardiovascular risk in Belgium.

摘要

背景

在心血管预防的背景下，识别心血管高危人群至关重要。准确性和精确性是风险评估的基本属性。我们开发了一个校准的 SCORE 风险图表（系统冠状动脉风险评估），用于计算发生致命心血管事件的绝对 10 年概率，该图表适用于比利时的全国死亡率统计数据和风险因素分布，并对其预测准确性进行了严格评估。

方法

我们使用 6212 名无冠心病的非糖尿病男性和女性的前瞻性队列研究（比利时营养与健康联合大学研究）的数据验证了我们的 SCORE 比利时风险图表。通过使用卡方和 Hosmer-Lemeshow 统计数据研究了整个风险范围内预测和观察到的 CVD 死亡数量之间的一致性。根据 Harrell 的 c 统计量评估风险估计的区分能力。

结果

在 10 年期间，观察到 274 例 CVD 死亡，而重新校准的风险图表预测了 263 例事件。SCORE 比利时风险图表在整个预测风险范围内显示出非常好的准确性（Hosmer-Lemeshow：P=0.14）。ROC 分析显示，在标记未来致命心血管疾病病例方面具有出色的区分能力，c 统计量为 0.86。10 年心血管死亡概率的 5%阈值具有最佳的敏感性和特异性平衡。