PDF(Pubmed)
Abstract：
UNASSIGNED: Risk assessment is essential in the prevention of cardiovascular disease. In patients with recent acute coronary syndrome (ACS) or coronary revascularization, risk prediction tools, like the European Society of Cardiology guideline recommended SMART-REACH risk score, are increasingly used to predict the risk of recurrent cardiovascular events enabling risk-based personalized prevention. However, little is known about the association between risk stratification and the social and healthcare costs at a population level. This study evaluated the associations between baseline SMART-REACH risk scores, long-term recurrent clinical events, cumulative costs, and post-index event LDL-C goal attainment in patients with recent ACS and/or revascularization.
UNASSIGNED: This retrospective study used electronic health records and was conducted in the North Karelia region of Finland. The study cohort included all patients aged 45-85 admitted to a hospital for ACS or who underwent percutaneous coronary intervention or coronary artery bypass surgery between 1 January 2017 and 31 December 2021. Patients were divided into quintiles based on their baseline SMART-REACH risk scores to examine the associations between predicted 5-year scores and selected clinical and economic outcomes. In addition, simple age-based stratification was conducted as a sensitivity analysis. The observed 5-year cumulative incidence of recurrent events ranged from 20% in the lowest to 41% in the highest risk quintile, whereas the corresponding predicted risks ranged from 13% to 51%, and cumulative 5-year mean total costs per patient ranged from 15 827 to 46 182€, respectively. Both monitoring and attainment of low LDL-C values were suboptimal.
UNASSIGNED: The use of the SMART-REACH quintiles as a population-level risk stratification tool successfully stratified patients into subgroups with different cumulative numbers of recurrent events and cumulative total costs. However, more research is needed to define clinically and economically optimal threshold values for a population-level stratification.
UNASSIGNED: This retrospective study used electronic health records and was conducted in the North Karelia region of Finland. The study cohort included all patients aged 45-85 admitted to a hospital for ACS or who underwent percutaneous coronary intervention or coronary artery bypass surgery between 1 January 2017 and 31 December 2021. Patients were divided into quintiles based on their baseline SMART-REACH risk scores to examine the associations between predicted 5-year scores and selected clinical and economic outcomes. In addition, simple age-based stratification was conducted as a sensitivity analysis. The observed 5-year cumulative incidence of recurrent events ranged from 20% in the lowest to 41% in the highest risk quintile, whereas the corresponding predicted risks ranged from 13% to 51%, and cumulative 5-year mean total costs per patient ranged from 15 827 to 46 182€, respectively. Both monitoring and attainment of low LDL-C values were suboptimal.
UNASSIGNED: The use of the SMART-REACH quintiles as a population-level risk stratification tool successfully stratified patients into subgroups with different cumulative numbers of recurrent events and cumulative total costs. However, more research is needed to define clinically and economically optimal threshold values for a population-level stratification.
摘要：
风险评估对于预防心血管疾病至关重要。在近期急性冠脉综合征（ACS）或冠脉血运重建的患者中，风险预测工具，像欧洲心脏病学会指南推荐的SMART-REACH风险评分，越来越多地用于预测复发性心血管事件的风险，从而实现基于风险的个性化预防。然而,关于风险分层与人口水平的社会和医疗成本之间的关系知之甚少。这项研究评估了基线SMART-REACH风险评分之间的关联，长期复发临床事件，累积成本，以及近期ACS和/或血运重建患者的指标事件后LDL-C目标达成情况。
■这项回顾性研究使用了电子健康记录，并在芬兰的北卡累利阿地区进行。该研究队列包括2017年1月1日至2021年12月31日期间因ACS入院或接受经皮冠状动脉介入治疗或冠状动脉搭桥手术的所有45-85岁患者。根据基线SMART-REACH风险评分将患者分为五分之一，以检查预测的5年评分与选定的临床和经济结果之间的关联。此外,进行简单的基于年龄的分层作为敏感性分析.观察到的5年复发事件的累积发生率从最低的20%到最高风险五分之一的41%不等。而相应的预测风险从13%到51%不等，每位患者的累计5年平均总费用为15827至46182欧元，分别。监测和达到低LDL-C值都是次优的。
■使用SMART-REACH五分位数作为人群水平的风险分层工具成功地将患者分层为具有不同累计复发事件数和累计总费用的亚组。然而,需要更多的研究来确定人群分层的临床和经济上的最佳阈值.
■这项回顾性研究使用了电子健康记录，并在芬兰的北卡累利阿地区进行。该研究队列包括2017年1月1日至2021年12月31日期间因ACS入院或接受经皮冠状动脉介入治疗或冠状动脉搭桥手术的所有45-85岁患者。根据基线SMART-REACH风险评分将患者分为五分之一，以检查预测的5年评分与选定的临床和经济结果之间的关联。此外,进行简单的基于年龄的分层作为敏感性分析.观察到的5年复发事件的累积发生率从最低的20%到最高风险五分之一的41%不等。而相应的预测风险从13%到51%不等，每位患者的累计5年平均总费用为15827至46182欧元，分别。监测和达到低LDL-C值都是次优的。
■使用SMART-REACH五分位数作为人群水平的风险分层工具成功地将患者分层为具有不同累计复发事件数和累计总费用的亚组。然而,需要更多的研究来确定人群分层的临床和经济上的最佳阈值.
