Comparative performance of the two pooled cohort equations for predicting atherosclerotic cardiovascular disease.
Comparative performance of the two pooled cohort equations for predicting atherosclerotic cardiovascular disease.
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DOI：
10.1016/j.atherosclerosis.2021.08.034
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发表时间：
2021-10
期刊：
影响因子：
5.3
通讯作者：
Luzum JA
中科院分区：
文献类型：
--
作者：
Campos-Staffico AM;Cordwin D;Murthy VL;Dorsch MP;Luzum JA
已经开发出多变量算法来预测动脉粥样硬化性心血管疾病 (ASCVD) 的风险，从而识别高危患者。在引入 AHA/ACC 队列方程 (PCE) 后不久，就发现了系统性高估风险的情况。因此，建议修订 PCE 以更准确地评估 ASCVD 风险。本研究旨在比较两种 PCE 在预测美国大量真实患者群体中 ASCVD 风险方面的准确性。这项回顾性队列研究确定了学术医疗系统中 20,843 名年龄在 40-75 岁之间且既往没有 ASCVD 的患者。使用贝叶斯信息准则 (BIC)、Hosmer-Lemeshow 检验、ROC 曲线下面积 (AUC)、Brier 评分和精确回忆分析来比较 PCE 之间的模型拟合、校准、区分和风险重新分类。此外，我们还检查了种族和性别亚组的影响修正。两种 PCE 均显示较差的校准（Hosmer-Lemeshow χ2>20；p<0.05）和辨别力（AUC<0.7）。 AUC 精确回忆曲线（AUCPR：0.0717 vs 0.0698）证实了修订后的 PCE 的辨别力缺乏改善（AUC：0.677 vs 0.679；p=0.357）。相比之下，尽管校准曲线重叠，但与修订后的 PCE 相比，AHA/ACC PCE 显示出强烈的正风险预测 (ΔBIC>10)。在这项单中心分析中，在随访了 2 年多的大量真实世界患者群体中，两种 PCE 对 ASCVD 风险的校准和辨别能力都很差。没有证据表明修订后的 PCE 在评估与 AHA/ACC PCE 相关的 ASCVD 风险方面的准确性有所提高。
Multivariable algorithms have been developed to predict the risk of atherosclerotic cardiovascular disease (ASCVD) to identify high-risk patients. Shortly after the introduction of the AHA/ACC Pooled Cohort Equations (PCE), a systematic overestimation of risk was identified. As such, a revised PCE was proposed to more accurately assess ASCVD risk. This study aims to compare the accuracy of both PCE in predicting the ASCVD risk within a large, real-world patient population in the US. This retrospective cohort study identified 20,843 patients aged between 40-75 years with no previous ASCVD in an academic healthcare system. Model fit, calibration, discrimination and risk reclassification were compared between PCE using Bayesian Information Criterion (BIC), Hosmer-Lemeshow test, area under the ROC curves (AUC), Brier score, and precision-recall analysis. In addition, we examined race and gender subgroups for effect modification. Both PCE showed poor calibration (Hosmer-Lemeshow χ2>20; p<0.05) and discrimination (AUC<0.7). The lack of improvement in discrimination of the revised PCE (AUC: 0.677 vs 0.679; p=0.357) was confirmed with the AUC precision-recall curves (AUCPR: 0.0717 vs 0.0698). In contrast, the AHA/ACC PCE showed a strong positive risk prediction (ΔBIC>10) compared to the revised PCE, although calibration curves had overlapped. In this single center analysis, both PCE had poor calibration and discrimination of ASCVD risk in a large, real-world patient population followed up for over 2 years. There was no evidence of improvement in the accuracy of the revised PCE in assessing the risk of ASCVD in relation to the AHA/ACC PCE.
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