Thus far, the vast majority of the CVD prediction models were derived and validated in Western populations- with only a small number validated in the Southeast Asian population ( 14). Usage of CVD risk prediction models in clinical medicine is important for stratifying risks in individuals to allow for a more personalized, and eventually cost-effective treatment. This highlights the importance of using locally adapted strategies and locally validated tools for better prevention strategies to improve survival and quality of life. Pre-eminently, evidence on risk factors of MACE in Asian populations has been conflicting ( 10– 13). Amongst the determinants of MACE, ethnicity is an important contributor to the relationship between risk factors and coronary artery disease severity ( 10). Despite the global improvements in prevention and healthcare, the prevalence of major adverse cardiovascular events (MACE) has been increasing with several trends in Southeast Asia being worse than in other regions ( 7– 9). Patients having a recent acute myocardial infarction (AMI) event, a common presentation of coronary artery disease, are at a higher risk of secondary events such as recurrent AMI, heart failure, and even mortality ( 6). In Southeast Asia, the burden of CVD has been reported to be increasing throughout the region even in rural and urban settings of low-income countries such as Cambodia and Myanmar ( 2– 5). Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better.Ĭardiovascular diseases (CVDs) are a major cause of disability and premature death globally-especially in low- and middle-income countries ( 1). However, with the limited strength of evidence, these results should be interpreted with caution. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies.Ĭonclusion: Both TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. Recalibrated and new models demonstrated marginal improvements in discriminative values. 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). Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. Both short- and long-term outcomes were assessed. Results: We included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review. 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. Methods: We searched MEDLINE and Cochrane Central databases until March 2022. 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 3Department of Cardiology, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysiaīackground: 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.2Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.1Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia.Sophia Rasheeqa Ismail 1,2, Muhamad Khairul Nazrin Khalil 1, Mohd Shawal Faizal Mohamad 3 and Shamsul Azhar Shah 2 *
0 kommentar(er)
