Belahnech Yassin, Ródenas-Alesina Eduard, Muñoz Miguel Ángel, Verdu-Rotellar Jose María, Sao-Avilés Augusto, Urio-Garmendia Garazi, Osorio Dimelza, Salas Karla, Pantoja Efrain, Ribera Aida, Ferreira-González Ignacio
Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain.
Eur J Prev Cardiol. 2025 May 12;32(7):527-536. doi: 10.1093/eurjpc/zwae383.
European Systematic Coronary Risk Assessment 2 for Older Persons (SCORE2-OP) model has shown modest performance when externally validated in selected cohorts. We aim to investigate its predictive performance and clinical utility for 10-year cardiovascular (CV) risk in an unbiased and representative cohort of older people of a low CV risk country. Furthermore, we explore whether other clinical or echocardiographic features could improve its performance.
A cohort of randomly selected individuals ≥65 years from a primary care population of Barcelona without established CV disease included 791 patients (63.1% female, median age 76 years, median follow-up 11.8 years). The model's performance yielded a Harrell's C-statistic of 0.706 (95% confidence interval [CI] 0.659-0.753) for the primary endpoint (myocardial infarction, stroke, and CV mortality) and 0.692 (95% CI 0.649-0.734) for the secondary endpoint (primary endpoint plus heart failure hospitalization), with better discrimination in females. SCORE2-OP underestimated the risk of primary endpoint in women [expected/observed (E/O) = 0.77], slightly overestimated in men (E/O = 1.06), and systematically underestimated the risk of the secondary endpoint (E/O = 0.52). Decision curve analysis showed net clinical benefit across a 7.5-30% risk range for primary endpoint. Valvular calcification was the only variable that significantly improved 10-year SCORE2-OP risk performance for both primary and secondary endpoints, with a change in Harrell's C of 0.028 (P = 0.017).
In a low CV risk country, SCORE2-OP showed notable discrimination and excellent calibration to predict 10-year CV risk, with better performance in females. Incorporating valvular calcification in a future revised score may enhance accuracy and reduce unnecessary treatments.
欧洲老年人系统性冠状动脉风险评估2（SCORE2-OP）模型在选定队列中进行外部验证时表现一般。我们旨在调查其在一个心血管疾病风险较低国家的无偏倚且具代表性的老年人群队列中对10年心血管（CV）风险的预测性能和临床效用。此外，我们探讨其他临床或超声心动图特征是否能改善其性能。
从巴塞罗那初级保健人群中随机选取的≥65岁且无既定心血管疾病的队列包括791名患者（女性占63.1%，中位年龄76岁，中位随访11.8年）。该模型对主要终点（心肌梗死、中风和心血管疾病死亡率）的性能产生的Harrell's C统计量为0.706（95%置信区间[CI] 0.659 - 0.753），对次要终点（主要终点加心力衰竭住院）为0.692（95% CI 0.649 - 0.734），女性的区分度更好。SCORE2-OP低估了女性主要终点的风险[预期/观察值（E/O）= 0.77]，男性略高估（E/O = 1.06），并系统性低估了次要终点的风险（E/O = 0.52）。决策曲线分析显示在主要终点7.5 - 30%的风险范围内有净临床益处。瓣膜钙化是唯一能显著改善主要和次要终点10年SCORE2-OP风险性能的变量，Harrell's C变化为0.028（P = 0.017）。
在一个心血管疾病风险较低的国家，SCORE2-OP在预测10年心血管疾病风险方面显示出显著的区分度和良好的校准度，女性表现更佳。在未来修订的评分中纳入瓣膜钙化可能会提高准确性并减少不必要的治疗。
