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Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction

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dc.contributor.authorSophia Rasheeqa Ismail
dc.contributor.authorMuhamad Khairul Nazrin Khalil
dc.contributor.authorMohd Shawal Faizal Mohamad
dc.contributor.authorShamsul Azhar Shah
dc.date.accessioned2024-07-15T07:03:19Z
dc.date.available2024-07-15T07:03:19Z
dc.date.issued2022
dc.description.abstract<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>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</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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, <jats:italic>n</jats:italic> = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772–0.83, <jats:italic>n</jats:italic> = 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Systematic review registration</jats:title><jats:p><jats:ext-link>https://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486</jats:ext-link>.</jats:p></jats:sec>
dc.identifier.doi10.3389/fcvm.2022.921044
dc.identifier.urihttps://repository.nih.gov.my/handle/123456789/528
dc.relation.ispartofFrontiers in Cardiovascular Medicine
dc.relation.issn2297-055X
dc.titleSystematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction
dc.typejournal-article
dspace.entity.typePublication
oaire.citation.volume9
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