New Pooled Cohort Risk equations: Application to a recent stroke patient population

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:348

Article

Park, Jong-Ho^1,2  Kwon, Hyung-Min³  Ovbiagele, Bruce² 

[1] Myongji Hosp, Dept Neurol, Goyang, South Korea

[2] Med Univ S Carolina, Dept Neurosci, Charleston, SC 29425 USA

[3] SMG SNU Boramae Med Ctr, Dept Neurol, Seoul, South Korea

关键词: Cardiovascular;    Atherosclerosis;    Stroke;    Coronary heart disease;    Vascular death;    Outcome;   

DOI  :  10.1016/j.jns.2014.11.028

来源: Elsevier

【 摘 要 】

Background: Recently, Pooled Cohort Risk (PCR) equations, which incorporate new sex- and race-specific estimates of the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) including stroke, for ASCVD-free adults were introduced. Given the importance of secondary stroke prevention and benefit of a potential tool to readily identify stroke patients at high intermediate-term vascular risk for appropriate treatment we evaluated the prediction and discrimination of the PCR and Framingham Cardiovascular Risk (FCR) equations after a recent stroke. Method: We conducted an analysis of Vitamin Intervention for Stroke Prevention dataset of 3555 recent non-cardioembolic stroke patients aged >= 35 years and followed for 2 years. Subjects were categorized as having low-PCR/low-FCR (<20%), high-PCR/high-FCR (>= 20%), and known-ASCVD. Independent associations of high-PCR/high-FCR with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed. Results: Both PCR and FCR were independently related to both outcomes: compared with low-PCR, high-PCR was associated with stroke (adjusted hazard ratio, 1.79; 95% CI, 1.25-2.57) and stroke/CHD/vascular death (2.05; 1.55-2.70). Compared with low-FCR, high-FCR was associated with stroke (2.06:1.34-3.16) and stroke/CHD/vascular death (1.57; 1.12-2.20). The c-statistic of PCR/FCR as a continuous variable for stroke was 0.56 (95% Cl, 0.54-0.58) and 0.56 (0.54-0.57), respectively and for stroke/CHD/vascular death was 0.62 (0.60-0.63) and 0.61 (0.59-0.63), respectively. Conclusions: Both PCR and FCR are significant predictors of recurrent vascular events among patients after a recent non-cardioembolic stroke, but neither one of them is an optimal model for discriminating intermediate-term ASCVD prediction among stroke patients already receiving secondary stroke prevention. (C) 2014 Elsevier B.V. All rights reserved.

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