Lupus & antiphospholipid syndrome
Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools
Authors' conclusion
Clinical CVR prediction tools underestimate actual high ASCVR in APS.
Study context
- Population
- Antiphospholipid syndrome (APS) patients (mean age 45.8±11.8 years; women 68.6%)
- Participants
- 121 patients
- Exposure
- Clinical cardiovascular risk (CVR) prediction tools vs carotid/femoral vascular ultrasound (VUS)-detected atherosclerotic plaques
- Outcome
- Calibration, discrimination and classification accuracy of prediction models to identify high ASCVR due to VUS-detected atherosclerotic plaques
Methodological detailsperformance analysis of nine clinical risk prediction tools
- Performance analysis of nine clinical risk prediction tools
Main finding
As reported in the abstract
Performance of all risk models
Spiegelhalter's z-test p values (moderate calibration)
0.47-0.57
AUROC (poor-to-acceptable discrimination)
0.56-0.75
Matthews correlation coefficient (MCC) (negligible-to-moderate classification accuracy)
0.01-0.35
Observational data: associations, not effects.
Further findings
| Outcome | SMART | aGAPSSCVD |
|---|---|---|
| Performance of recurrent-CVD tools (z-test p / AUROC / MCC) | ||
| Spiegelhalter's z-test p | 0.47 | 0.52 |
| AUROC | 0.64 | 0.69 |
| MCC | 0.29 | 0.29 |
- Performance of recurrent-CVD tools (z-test p / AUROC / MCC): aGAPSSCVD for non-triple antiphospholipid antibody-positive patients
Performance of recurrent-CVD tools (z-test p / AUROC / MCC)
- SMART and aGAPSSCVD performed better than adjusted Global APS Score (aGAPSS)
VUS reclassification of patients classified as non-high-ASCVR
- Reclassified by VUS, first-CVD prediction models
- 34.2%-47.9%
- Reclassified by VUS, recurrent-CVD prediction models
- 40.5%-52.6%
VUS-guided reclassification in patients aged 40-54 years (subgroup)
- First-CVD risk tools
- >40%
- Recurrent-CVD prediction models
- >50%
Original publication
Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools. RMD Open. Published 27 November 2023. doi:10.
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