基于 PROCAM 的心肌梗死风险与全球血管疾病风险的关系：来自 ARCO 队列研究的观察结果。

PROCAM based myocardial infarction risk in relation to global vascular disease risk: observations from the ARCO cohort study.

机构信息

Vascular Risk Foundation (Varifo), Olten, Switzerland.

BAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Bonn, Germany.

出版信息

Swiss Med Wkly. 2022 Feb 22;152:w30111. doi: 10.4414/smw.2022.w30111. eCollection 2022 Feb 14.

DOI:10.4414/smw.2022.w30111

PMID:35201684

Abstract

BACKGROUND

In Switzerland, risk for acute myocardial infarction (AMI) has been considered as equivalent to risk for atherosclerotic cardiovascular disease (ASCVD). This may lead to an underestimation of ASCVD risk and prevent adequate preventive measures.

METHODS

We calculated correction factors for AMI risk to obtain ASCVD risk, tested predicting abilities of PROCAM/AGLA, SCORE, HerzCheck® and carotid plaque imaging (TPA) for ASCVD events in this cohort study and calculated survival curves, calibration and discrimination for ASCVD outcomes derived from PROCAM/AGLA, SCORE and TPA.

RESULTS

In 2842 subjects (age 50 ± 8, 38% women), 154 (5.4%) cardiovascular events occurred (ASCVD: 41 myocardial infarctions, 16 strokes or TIAs, 21 CABG, 41 PTCA, 35 coronary artery disease [CAD]defined by invasive angiography) during a mean follow-up time of 5.9 (1-12) years. AGLA-AMI risk was well calibrated for AMI (15% underreported risk for the risk of AMI), but was poorly calibrated for ASCVD (stroke, CABG, PTCA or CAD, which contributed to the secondary outcome variables) with underreported risk resulting in a correction factor of 3.45. Discrimination was comparable for all risk calculators, but TPA outperformed risk calculators for survival using Cox proportional survival functions. Net reclassification improvement for PROCAM and SCORE using TPA tertiles groups increased significantly between 30% to 48%.

CONCLUSIONS

PROCAM-derived risk calculators are well calibrated for the risk of AMI. PROCAM-AMI should be multiplied by a factor of 4 to obtain ASCVD. PROCAM-AMI does not represent global cardiovascular risk. Corresponding adjustments in the AGLA communication of risk appear necessary.

摘要

背景

在瑞士，急性心肌梗死（AMI）风险被认为等同于动脉粥样硬化性心血管疾病（ASCVD）风险。这可能导致对 ASCVD 风险的低估，并阻止采取充分的预防措施。

方法

我们计算了 AMI 风险的校正因子，以获得 ASCVD 风险，在这项队列研究中检验了 PROCAM/AGLA、SCORE、HerzCheck®和颈动脉斑块成像（TPA）对 ASCVD 事件的预测能力，并计算了源于 PROCAM/AGLA、SCORE 和 TPA 的 ASCVD 结局的生存曲线、校准和区分度。

结果

在 2842 名受试者（年龄 50±8 岁，38%为女性）中，在平均 5.9（1-12）年的随访期间，发生了 154 例心血管事件（ASCVD：41 例心肌梗死、16 例卒中和 TIA、21 例 CABG、41 例 PTCA、35 例经血管造影定义的 CAD）。AGLA-AMI 风险对 AMI 有很好的校准（AMI 风险的 15%被低估），但对 ASCVD 的校准很差（中风、CABG、PTCA 或 CAD，这些构成了次要结局变量），低估风险导致校正因子为 3.45。所有风险计算器的区分度相当，但使用 Cox 比例生存函数，TPA 的表现优于风险计算器。使用 TPA 三分位组，PROCAM 和 SCORE 的净重新分类改善显著增加 30%至 48%。