Oksanen Minna, Parviainen Jenna, Asseburg Christian, Hageman Steven, Rissanen Tuomas T, Kivelä Annukka, Taipale Kristian, Visseren Frank, Martikainen Janne
ESiOR Oy, Tulliportinkatu 2, 70100 Kuopio, Finland.
Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
Eur Heart J Open. 2024 Jun 18;4(4):oeae049. doi: 10.1093/ehjopen/oeae049. eCollection 2024 Jul.
Risk assessment is essential in the prevention of cardiovascular disease. In patients with recent acute coronary syndrome (ACS) or coronary revascularization, risk prediction tools, like the European Society of Cardiology guideline recommended SMART-REACH risk score, are increasingly used to predict the risk of recurrent cardiovascular events enabling risk-based personalized prevention. However, little is known about the association between risk stratification and the social and healthcare costs at a population level. This study evaluated the associations between baseline SMART-REACH risk scores, long-term recurrent clinical events, cumulative costs, and post-index event LDL-C goal attainment in patients with recent ACS and/or revascularization.
This retrospective study used electronic health records and was conducted in the North Karelia region of Finland. The study cohort included all patients aged 45-85 admitted to a hospital for ACS or who underwent percutaneous coronary intervention or coronary artery bypass surgery between 1 January 2017 and 31 December 2021. Patients were divided into quintiles based on their baseline SMART-REACH risk scores to examine the associations between predicted 5-year scores and selected clinical and economic outcomes. In addition, simple age-based stratification was conducted as a sensitivity analysis. The observed 5-year cumulative incidence of recurrent events ranged from 20% in the lowest to 41% in the highest risk quintile, whereas the corresponding predicted risks ranged from 13% to 51%, and cumulative 5-year mean total costs per patient ranged from 15 827 to 46 182€, respectively. Both monitoring and attainment of low LDL-C values were suboptimal.
The use of the SMART-REACH quintiles as a population-level risk stratification tool successfully stratified patients into subgroups with different cumulative numbers of recurrent events and cumulative total costs. However, more research is needed to define clinically and economically optimal threshold values for a population-level stratification.
风险评估在心血管疾病预防中至关重要。在近期急性冠状动脉综合征（ACS）患者或接受冠状动脉血运重建的患者中，风险预测工具，如欧洲心脏病学会指南推荐的SMART-REACH风险评分，越来越多地用于预测复发性心血管事件的风险，以实现基于风险的个性化预防。然而，在人群层面，关于风险分层与社会和医疗成本之间的关联知之甚少。本研究评估了近期ACS和/或血运重建患者的基线SMART-REACH风险评分、长期复发性临床事件、累积成本以及索引事件后低密度脂蛋白胆固醇（LDL-C）目标达成情况之间的关联。
这项回顾性研究使用电子健康记录，在芬兰北卡累利阿地区进行。研究队列包括2017年1月1日至2021年12月31日期间因ACS入院或接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的所有45 - 85岁患者。根据患者的基线SMART-REACH风险评分将其分为五个五分位数，以检查预测的5年评分与选定的临床和经济结果之间的关联。此外，进行基于年龄的简单分层作为敏感性分析。观察到的复发性事件的5年累积发生率在最低风险五分位数中为20%，在最高风险五分位数中为41%，而相应的预测风险范围为13%至51%，每位患者的5年累积平均总成本分别为15827至46182欧元。低密度脂蛋白胆固醇值的监测和达标情况均不理想。
使用SMART-REACH五分位数作为人群层面的风险分层工具成功地将患者分为具有不同复发性事件累积数和累积总成本的亚组。然而，需要更多研究来确定人群层面分层的临床和经济最佳阈值。
