Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Prev Med. 2013 Oct;57(4):328-33. doi: 10.1016/j.ypmed.2013.06.007. Epub 2013 Jun 13.
The objective of this study is to compare the clinical performance of different strategies, REASON, PREVALENT, Inter-Society Consensus (ISC), and the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines, in the selection of candidates for peripheral artery disease (PAD) screening using ankle-brachial index (ABI).
Our work is a population-based cross-sectional study conducted in Extremadura (Spain) in 2007-2009. Participants were ≥50years old and free of cardiovascular disease. ABI and cardiovascular risk factors were measured.
In total, 1288 individuals (53% women), with a mean age of 63years (standard deviation (SD) 9) were included. The prevalence of ABI <0.9 was 4.9%. REASON risk score identified 53% of the sample to screen with sensitivity of 87.3%, quite similar to that identified in ISC and ACC/AHA strategies (both 90.5%), and specificity of 48.3%, higher than that of the ISC (30.9%) and ACC/AHA (31.1%) strategies. Although the Youden index was 0.4 for both REASON and PREVALENT risk scores, the latter's sensitivity was 60.3%, almost 30 points less than all other strategies.
REASON risk score was the strategy with the highest clinical performance and efficiency, with sensitivity of 87.3% and specificity higher than that of the ISC and ACC/AHA strategies. Although very specific, the PREVALENT strategy had low sensitivity making it difficult to be implemented as a screening tool.
本研究旨在比较不同策略（REASON、PREVALENT、ISCA 和 ACC/AHA）在使用踝肱指数（ABI）筛选外周动脉疾病（PAD）患者时的临床性能。
本研究是 2007-2009 年在西班牙埃斯特雷马杜拉进行的一项基于人群的横断面研究。参与者年龄≥50 岁且无心血管疾病。测量了 ABI 和心血管危险因素。
共纳入 1288 名（53%为女性）年龄为 63 岁（标准差 9）的个体。ABI<0.9 的患病率为 4.9%。REASON 风险评分识别出 53%的样本进行筛查，其敏感性为 87.3%，与 ISC 和 ACC/AHA 策略（均为 90.5%）相当，特异性为 48.3%，高于 ISC（30.9%）和 ACC/AHA（31.1%）策略。尽管 REASON 和 PREVALENT 风险评分的约登指数均为 0.4，但后者的敏感性为 60.3%，比所有其他策略低近 30 个百分点。
REASON 风险评分是临床性能和效率最高的策略，其敏感性为 87.3%，特异性高于 ISC 和 ACC/AHA 策略。尽管 PREVALENT 策略非常特异，但敏感性较低，难以作为筛查工具实施。
