PDF(Pubmed)
Abstract：
Stroke risk is currently estimated as part of the composite risk of cardiovascular disease (CVD). We investigated if composite-CVD risk prediction tools QRISK3 and Pooled Cohort Equations-PCE, derived from middle-aged adults, are as good as stroke-specific Framingham Stroke Risk Profile-FSRP and QStroke for capturing the true risk of stroke in older adults. External validation for 10y stroke outcomes was performed in men (60-79y) of the British Regional Heart Study. Discrimination and calibration were assessed in separate validation samples (FSRP n = 3762, QStroke n = 3376, QRISK3 n = 2669 and PCE n = 3047) with/without adjustment for competing risks. Sensitivity/specificity were examined using observed and clinically recommended thresholds. Performance of FSRP, QStroke and QRISK3 was further compared head-to-head in 2441 men free of a range of CVD, including across age-groups. Observed 10y risk (/1000PY) ranged from 6.8 (hard strokes) to 11 (strokes/transient ischemic attacks). All tools discriminated weakly, C-indices 0.63-0.66. FSRP and QStroke overestimated risk at higher predicted probabilities. QRISK3 and PCE showed reasonable calibration overall with minor mis-estimations across the risk range. Performance worsened on adjusting for competing non-stroke deaths. However, in men without CVD, QRISK3 displayed relatively better calibration for stroke events, even after adjustment for competing deaths, including in oldest men. All tools displayed similar sensitivity (63-73 %) and specificity (52-54 %) using observed risks as cut-offs. When QRISK3 and PCE were evaluated using thresholds for CVD prevention, sensitivity for stroke events was 99 %, with false positive rate 97 % suggesting existing intervention thresholds may need to be re-examined to reflect age-related stroke burden.
摘要：
目前，中风风险被估计为心血管疾病（CVD）复合风险的一部分。我们调查了复合CVD风险预测工具QRISK3和集合队列方程-PCE，来自中年人，与卒中特异性弗雷明汉卒中风险概况-FSRP和QStroke一样好，可以捕获老年人卒中的真实风险。在英国区域心脏研究的男性（60-79y）中进行了10y卒中结局的外部验证。在单独的验证样本（FSRPn=3762，QStroken=3376，QRISK3n=2669和PCEn=3047）中评估歧视和校准，并/不调整竞争风险。使用观察到的和临床推荐的阈值检查敏感性/特异性。FSRP的性能，QStroke和QRISK3在2441名没有心血管疾病的男性中进行了头对头的比较，包括跨年龄组。观察到的10y风险（/1000PY）范围为6.8（硬性中风）至11（中风/短暂性脑缺血发作）。所有工具歧视都很弱，C指数0.63-0.66。FSRP和QStroke在更高的预测概率下高估了风险。QRISK3和PCE总体上显示出合理的校准，在整个风险范围内略有错误估计。在调整竞争性非中风死亡后，性能恶化。然而,在没有心血管疾病的男性中，QRISK3显示出相对更好的中风事件校准，即使在对竞争性死亡进行调整之后，包括最年长的男人。使用观察到的风险作为截止值，所有工具均显示出相似的灵敏度（63-73％）和特异性（52-54％）。当使用CVD预防阈值评估QRISK3和PCE时，对卒中事件的敏感性为99%,97%的假阳性率提示现有的干预阈值可能需要重新检查以反映年龄相关的卒中负担.
