Key result
The RiskJBS calculator identified the highest proportion of acute MI patients as high-risk, with only 44.1% estimated at <20% 10-year risk compared to 86.6% with RiskWHO (P<0.01).
Why the study?
Does the RiskJBS score identify a higher proportion of Indian patients as high-risk prior to their first MI compared to RiskWHO, RiskFRS, and RiskACC/AHA?
Observational (n=149)
Does the RiskJBS score identify a higher proportion of Indian patients as high-risk prior to their first MI compared to RiskWHO, RiskFRS, and RiskACC/AHA?
Absolute Event Rate: 44.1% vs 86.6%
p-value: p=<0.01
In Indian patients presenting with a first MI, the JBS3 risk calculator retrospectively identified a higher proportion of patients as high-risk compared to WHO, Framingham, and ACC/AHA scores.
Current risk models may underestimate CV risk in Indians; leaves open need for ethnicity-specific recalibration and validation.
BACKGROUND: Although a number of risk assessment models are available for estimating 10-year risk of cardiovascular (CV) events in patients requiring primary prevention of CV disease, the predictive accuracy of the contemporary risk models has not been adequately evaluated in Indians. METHODS: 149 patients [mean age 59.4 ± 10.6 years; 123 (82.6%) males] without prior CV disease and presenting with acute myocardial infarction (MI) were included. The four clinically most relevant risk assessment models [Framingham Risk score (RiskFRS), World Health Organization risk prediction charts (RiskWHO), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA) and the 3rd Joint British Societies' risk calculator (RiskJBS)] were applied to estimate what would have been their predicted 10-year risk of CV events if they had presented just prior to suffering the acute MI. RESULTS: RiskWHO provided the lowest risk estimates with 86.6% patients estimated to be having <20% 10-year risk. In comparison, RiskFRS and RiskACC/AHA returned higher risk estimates (61.7% and 69.8% with risk <20%, respectively; p values <0.001 for comparison with RiskWHO). However, the RiskJBS identified the highest proportion of the patients as being at high-risk (only 44.1% at <20% risk, p values 0 < 0.01 for comparison with all the other 3 risk scores). CONCLUSIONS: This is the first study to show that in Indian patients presenting with acute MI, RiskJBS is likely to identify the largest proportion of the patients as at 'high-risk' as compared to RiskWHO, RiskFRS and RiskACC/AHA. However, large-scale prospective studies are needed to confirm these findings.
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Bansal et al. (2014) conducted an observational in Acute myocardial infarction (n=149). RiskJBS (3rd Joint British Societies' risk calculator) vs. RiskWHO, RiskFRS, and RiskACC/AHA was evaluated on Proportion of patients estimated to have <20% 10-year risk of cardiovascular events (p=<0.01). The RiskJBS calculator identified the highest proportion of acute MI patients as high-risk, with only 44.1% estimated at <20% 10-year risk compared to 86.6% with RiskWHO (P<0.01).
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