| アブストラクト | AIMS: The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. METHODS AND RESULTS: Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. CONCLUSION: The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk. |
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| 投稿者 | Hageman, Steven H J; McKay, Ailsa J; Ueda, Peter; Gunn, Laura H; Jernberg, Tomas; Hagstrom, Emil; Bhatt, Deepak L; Steg, Ph Gabriel; Lall, Kristi; Magi, Reedik; Gynnild, Mari Nordbo; Ellekjaer, Hanne; Saltvedt, Ingvild; Tunon, Jose; Mahillo, Ignacio; Acena, Alvaro; Kaminski, Karol; Chlabicz, Malgorzata; Sawicka, Emilia; Tillman, Taavi; McEvoy, John W; Di Angelantonio, Emanuele; Graham, Ian; De Bacquer, Dirk; Ray, Kausik K; Dorresteijn, Jannick A N; Visseren, Frank L J |
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| 組織名 | Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500,;3508 GA Utrecht, The Netherlands.;Department of Primary Care and Public Health, Imperial College London, London,;UK.;Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet,;Solna, Stockholm, Sweden.;Department of Public Health Sciences and School of Data Science, University of;North Carolina at Charlotte, Charlotte, NC, USA.;Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet,;Stockholm, Sweden.;Department of Medical Sciences, Uppsala University, Uppsala Clinical Research;Center, Uppsala, Sweden.;Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School,;Boston, MA, USA.;French Alliance for Cardiovascular Trials, Assistance Publique-Hopitaux de Paris,;Hopital Bichat, Universite de Paris, INSERM Unite, 1148 Paris, France.;Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu,;Estonia.;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health;Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.;Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University;Hospital, Trondheim, Norway.;Department of Geriatrics, Clinic of Medicine, St Olavs Hospital, Trondheim;University Hospital, Trondheim, Norway.;Department of Cardiology, Fundacion Jimenez Diaz, Madrid, Autonoma University,;Madrid, Spain.;CIBERCV, Madrid, Spain.;Department of Epidemiology, Fundacion Jimenez Diaz, Madrid, Spain.;Department of Population Medicine and Lifestyle Diseases Prevention, Medical;University of Bialystok, Bialystok, Poland.;Department of Invasive Cardiology, Medical University of Bialystok, Bialystok,;Poland.;Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.;Centre for Non-Communicable Disease, Institute for Global Health, University;College London, London, UK.;National Institute for Prevention and Cardiovascular Health, Galway, Ireland.;Galway Campus, National University of Ireland Galway, Galway, Ireland.;Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care,;University of Cambridge, Cambridge, UK.;School of Medicine, Trinity College Dublin, University of Dublin, Dublin,;Ireland.;Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. |
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