Park Jong-Ho, Kwon Hyung-Min, Ovbiagele Bruce
Department of Neurology, Myongji Hospital, Goyang, South Korea; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States.
Department of Neurology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
J Neurol Sci. 2015 Jan 15;348(1-2):160-5. doi: 10.1016/j.jns.2014.11.028. Epub 2014 Dec 3.
Recently, Pooled Cohort Risk (PCR) equations, which incorporate new sex- and race-specific estimates of the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) including stroke, for ASCVD-free adults were introduced. Given the importance of secondary stroke prevention and benefit of a potential tool to readily identify stroke patients at high intermediate-term vascular risk for appropriate treatment, we evaluated the prediction and discrimination of the PCR and Framingham Cardiovascular Risk (FCR) equations after a recent stroke.
We conducted an analysis of Vitamin Intervention for Stroke Prevention dataset of 3555 recent non-cardioembolic stroke patients aged ≥ 35 years and followed for 2 years. Subjects were categorized as having low-PCR/low-FCR (<20%), high-PCR/high-FCR (≥ 20%), and known-ASCVD. Independent associations of high-PCR/high-FCR with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed.
Both PCR and FCR were independently related to both outcomes: compared with low-PCR, high-PCR was associated with stroke (adjusted hazard ratio, 1.79; 95% CI, 1.25-2.57) and stroke/CHD/vascular death (2.05; 1.55-2.70). Compared with low-FCR, high-FCR was associated with stroke (2.06; 1.34-3.16) and stroke/CHD/vascular death (1.57; 1.12-2.20). The c-statistic of PCR/FCR as a continuous variable for stroke was 0.56 (95% CI, 0.54-0.58) and 0.56 (0.54-0.57), respectively and for stroke/CHD/vascular death was 0.62 (0.60-0.63) and 0.61 (0.59-0.63), respectively.
Both PCR and FCR are significant predictors of recurrent vascular events among patients after a recent non-cardioembolic stroke, but neither one of them is an optimal model for discriminating intermediate-term ASCVD prediction among stroke patients already receiving secondary stroke prevention.
最近，引入了汇总队列风险（PCR）方程，该方程纳入了针对无动脉粥样硬化性心血管疾病（ASCVD，包括中风）的成年人的10年风险的新的性别和种族特异性估计值。鉴于二级中风预防的重要性以及一种潜在工具对于轻松识别处于高中期血管风险的中风患者以进行适当治疗的益处，我们评估了近期中风后PCR和弗雷明汉心血管风险（FCR）方程的预测能力和辨别力。
我们对3555名年龄≥35岁的近期非心源性中风患者的中风预防维生素干预数据集进行了分析，并随访了2年。受试者被分类为低PCR/低FCR（<20%）、高PCR/高FCR（≥20%）和已知ASCVD。评估高PCR/高FCR与复发性中风（主要结局）以及中风/冠心病（CHD）/血管死亡（次要结局）的独立关联。
PCR和FCR均与两种结局独立相关：与低PCR相比，高PCR与中风相关（调整后的风险比，1.79；95%置信区间，1.25 - 2.57）以及中风/CHD/血管死亡相关（2.05；1.55 - 2.70）。与低FCR相比，高FCR与中风相关（2.06；1.34 - 3.16）以及中风/CHD/血管死亡相关（1.57；1.12 - 2.20）。PCR/FCR作为中风连续变量的c统计量分别为0.56（95%置信区间，0.54 - 0.58）和0.56（0.54 - 0.57），对于中风/CHD/血管死亡分别为0.62（0.60 - 0.63）和0.61（0.59 - 0.63）。
PCR和FCR均是近期非心源性中风患者复发性血管事件的重要预测指标，但它们都不是用于辨别已接受二级中风预防的中风患者中期ASCVD预测的最佳模型。
