Suwannasom Pannipa, Phinyo Phichayut, Leemasawat Krit, Chichareon Ply, Nantsupawat Teerapat, Osataphan Nichanan, Thonghong Tasalak, Suwanugsorn Saranyou, Wongvipaporn Chaiyasith, Phrommintikul Arintaya
Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Angiology. 2023 Oct;74(9):848-858. doi: 10.1177/00033197221124772. Epub 2022 Sep 3.
We aimed to evaluate the incremental prognostic value after incorporation of the ankle-brachial index (ABI) into the 10-year pool cohort equation (PCE) risk model in patients with multiple risk factors (MRFs). A total of 4332 MRFs patients were divided into 2 groups as ABI ≤.9 or >.9. The primary outcome was hard cardiovascular events (hCVE: including cardiovascular death, myocardial infarction, or ischemic stroke) over a median follow-up of 36 months. The Cox proportional hazards survival model, C-statistic, and net reclassification indices (NRI) were used. The occurrence of the primary outcome in the ABI ≤.9 group (3.7%) was significantly greater than in the ABI > .9 group (1.3%), < .001. ABI is an independent predictor of hCVE in addition to the variables in the standard risk model (age, gender, and smoking status). ABI modestly improved the C-index when added to the PCE risk model (PCE .70 vs ABI+PCE .74). The addition of ABI to the PCE risk model did not significantly improve the classification of patients (NRI -.029; 95% CI: -.215 to .130). Despite ABI being one of the independent predictors of hCVE, integration of ABI into the PCE model did not improve the efficacy of risk reclassification in patients with MRFs.
我们旨在评估在多危险因素（MRF）患者中，将踝臂指数（ABI）纳入10年汇总队列方程（PCE）风险模型后的增量预后价值。总共4332例MRF患者被分为两组，ABI≤0.9或>0.9。主要结局是在中位随访36个月期间发生的严重心血管事件（hCVE：包括心血管死亡、心肌梗死或缺血性中风）。使用了Cox比例风险生存模型、C统计量和净重新分类指数（NRI）。ABI≤0.9组的主要结局发生率（3.7%）显著高于ABI>0.9组（1.3%），P<0.001。除了标准风险模型中的变量（年龄、性别和吸烟状况）外，ABI还是hCVE的独立预测因素。当添加到PCE风险模型中时，ABI适度提高了C指数（PCE为0.70，ABI+PCE为0.74）。将ABI添加到PCE风险模型中并未显著改善患者的分类（NRI为-0.029；95%CI：-0.215至0.130）。尽管ABI是hCVE的独立预测因素之一，但将ABI纳入PCE模型并未提高MRF患者风险重新分类的效果。
