Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction.
Autor: | Ismail SR; Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia.; Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia., Khalil MKN; Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia., Mohamad MSF; Department of Cardiology, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia., Azhar Shah S; Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia. |
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Jazyk: | angličtina |
Zdroj: | Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Jul 26; Vol. 9, pp. 921044. Date of Electronic Publication: 2022 Jul 26 (Print Publication: 2022). |
DOI: | 10.3389/fcvm.2022.921044 |
Abstrakt: | Background: The cultural and genetic diversity of the Southeast Asian population has contributed to distinct cardiovascular disease risks, incidence, and prognosis compared to the Western population, thereby raising concerns about the accuracy of predicted risks of existing prognostic models. Objectives: We aimed to evaluate the predictive performances of validated, recalibrated, and developed prognostic risk prediction tools used in the Southeast Asian population with acute myocardial infarction (AMI) events for secondary events. Methods: We searched MEDLINE and Cochrane Central databases until March 2022. We included prospective and retrospective cohort studies that exclusively evaluated populations in the Southeast Asian region with a confirmed diagnosis of an AMI event and evaluated for risk of secondary events such as mortality, recurrent AMI, and heart failure admission. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review. Results: We included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. Both short- and long-term outcomes were assessed. Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. The pooled estimate of the C-statistic in the Southeast Asian population for GRACE risk score is 0.83 (95%CI 0.72-0.90, n = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772-0.83, n = 5 validations). Recalibrated and new models demonstrated marginal improvements in discriminative values. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies. Conclusion: Both TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, with the limited strength of evidence, these results should be interpreted with caution. Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Ismail, Khalil, Mohamad and Azhar Shah.) |
Databáze: | MEDLINE |
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