弗雷明汉心脏研究中一种新型心脏性猝死风险预测评分的验证

Validation of a Novel Risk Prediction Score for Sudden Cardiac Death in the Framingham Heart Study.

作者信息

Truyen Thien Tan Tri Tai, Lin Honghuang, Mathias Marco, Chugh Harpriya, Reinier Kyndaron, Benjamin Emelia J, Chugh Sumeet S

机构信息

Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (T.T.T.T.T., M.M., H.C., K.R., S.S.C.).

Department of Medicine, University of Massachusetts Chan Medical School, Worcester (H.L.).

出版信息

Circ Arrhythm Electrophysiol. 2025 Jun;18(6):e013647. doi: 10.1161/CIRCEP.124.013647. Epub 2025 May 20.

DOI:10.1161/CIRCEP.124.013647

PMID:40391444

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12173765/

Abstract

BACKGROUND

We have previously reported a novel clinical risk score (risk prediction score for shockable sudden cardiac arrest [VFRisk]) for the prediction of shockable sudden cardiac arrest, discovered and validated in 2 US west coast communities. We hypothesized that VFRisk predicts sudden cardiac death (SCD) risk in the geographically distinct FHS (Framingham Heart Study).

METHODS

We performed a nested case-referents study in the FHS to test VFRisk. Cases were participants who experienced SCD among the original and offspring FHS cohorts. Referents were randomly selected from FHS participants frequency-matched (ratio of 1:3) to cases on age, sex, cohort, and exam. VFRisk was the sum of 12 risk factors, each multiplied by its respective points.

RESULTS

Among 312 cases and 935 referents, mean ages were 69.5 and 69.7 years with 70.8% men in both groups. SCD cases had significantly higher prevalence of diabetes, heart failure, stroke, atrial fibrillation, and myocardial infarction compared with the referents group. The VFRisk score was validated with good discrimination (C-statistic, 0.71 [95% CI, 0.66-0.77]) for SCD. Cases had higher VFRisk scores than referents (3.8±2.8 versus 1.8±1.7; <0.001). A 1-unit increase in VFRisk score was associated with a 48% increase in odds of SCD (odds ratio, 1.48 [95% CI, 1.34-1.64]). The highest VFRisk quartile had 7.8-fold higher odds of SCD than the lowest quartile.

CONCLUSIONS

The VFRisk score successfully predicted SCD in the FHS. The differences in discrimination between the 2 studies could partially be explained by the inability to distinguish shockable versus nonshockable events in the FHS.

摘要

背景

我们之前报道了一种用于预测可电击复律的心搏骤停的新型临床风险评分（可电击复律的心搏骤停风险预测评分 [VFRisk]），该评分在2个美国西海岸社区发现并得到验证。我们假设VFRisk可预测地理位置不同的弗雷明汉心脏研究（FHS）中的心源性猝死（SCD）风险。

方法

我们在FHS中进行了一项巢式病例对照研究以检验VFRisk。病例为FHS原始队列和后代队列中发生SCD的参与者。对照从FHS参与者中随机选取，在年龄、性别、队列和检查方面与病例进行频率匹配（比例为1:3）。VFRisk是12个风险因素的总和，每个因素乘以其各自的分数。

结果

在312例病例和935例对照中，平均年龄分别为69.5岁和69.7岁，两组男性比例均为70.8%。与对照组相比，SCD病例中糖尿病、心力衰竭、中风、心房颤动和心肌梗死的患病率显著更高。VFRisk评分对SCD的验证具有良好的区分度（C统计量，0.71 [95% CI，0.66 - 0.77]）。病例的VFRisk评分高于对照（3.8±2.8对1.8±1.7；<0.001）。VFRisk评分每增加1个单位，SCD的几率增加48%（优势比，1.48 [95% CI，1.34 - 1.64]）。VFRisk最高四分位数组发生SCD的几率比最低四分位数组高7.8倍。