Arq. Bras. Cardiol. 2019; 113(1): 31-32
Is ProACS Score Just another Risk Stratification Score, or is it Ready for Implementation in Clinical Practice?
DOI: 10.5935/abc.20190122
This Short Editorial is referred by the Research article "Application of Risks Scores in Acute Coronary Syndromes. How Does ProACS Hold Up Against Other Risks Scores?".
Since the first publication of Framingham Risk Score in late 1950’s, derived from data obtained in an observational study to investigate cardiovascular risk factors, several other risk scores were created around the globe and they have been increasingly popular particularly in the last 10-20 years in cardiovascular medicine. The objective of a risk score is to individualize the risk for an individual patient with the use of functional equations based on multiple risk factors. Patients at high risk should be submitted to specific interventions to improve outcome.
Despite this huge increase in risk scoring development, most have not been implemented in clinical practice. In fact, many models showed low predictive performance (as assessed by their calibration and discrimination) and some are poorly reported or were developed using inappropriate methods. For that reason, international guidelines were developed for adequate development and reporting of prediction models. For that objective to be fulfilled, it should include an adequate selection of the development cohort, adequate methodology for selection of variables and an adequate validation, both internal and external. In fact, external validation is particularly important because it tests the performance of a prediction model in a different independent patient cohort, where they usually perform less well. It can also allow comparison with other risk stratification tools. This step is essential for safe implementation in clinical practice.
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