Department of Epidemiology, University of North Carolina at Chapel Hill.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Am J Med. 2018 May;131(5):532-539.e5. doi: 10.1016/j.amjmed.2017.12.002. Epub 2017 Dec 19.
Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death.
The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants.
During 10 years' follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P = .82; black-specific chi-squared 4.1, P = .77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99).
The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.
尽管心源性猝死是美国的主要致死原因之一，但大多数心源性猝死的受害者在死亡前并未被识别为高危人群。我们旨在推导并验证一种基于人群的风险评分，以预测心源性猝死。
ARIC（动脉粥样硬化风险社区）研究记录了基线时年龄在 45-64 岁的男性和女性的临床指标；本分析纳入了 11335 名白人和 3780 名黑人参与者。参与者随访 10 年，心源性猝死由医生裁定。Cox 比例风险模型用于推导种族特异性方程，以估计 10 年心源性猝死风险。风险评分的协变量选自可用的人口统计学和临床变量。通过计算判别（哈雷尔 C 指数）和校准（Hosmer-Lemeshow χ 平方检验）来评估效用。白种人特异性方程在Framingham 心脏研究的 5626 名参与者中进行了验证。
在 ARIC 参与者的 10 年随访期间（平均年龄 54.4 岁，52.4%为女性），有 145 名参与者经历了心源性猝死；大多数发生在预测风险最高的五分位数中。模型协变量包括年龄、性别、总胆固醇、降脂和高血压药物使用、血压、吸烟状况、糖尿病和体重指数。该评分具有非常好的内部判别能力（白人特异性 C 指数 0.82；95%置信区间 [CI]，0.78-0.85；黑人特异性 C 指数 0.75；95%CI，0.68-0.82），在Framingham 参与者中具有非常好的外部判别能力（C 指数 0.82；95%CI，0.79-0.86）。校准图表明在 ARIC 中具有极好的校准（白人特异性 χ 平方 5.3，P = 0.82；黑人特异性 χ 平方 4.1，P = 0.77），而在 Framingham 中进行简单的重新校准后拟合度极好（ χ 平方 2.1，P = 0.99）。
所提出的风险评分可用于识别 10 年内心源性猝死的高危人群，特别是可对风险最高的人群进行分类，这些人群可能需要进一步筛查。
