Validation Analysis of the Expanded Risk Score for Rheumatoid Arthritis in a Multicentre Italian Cohort

Fabio Cacciapaglia¹, Gian Luca Erre², Matteo Piga³, Elena Bartoloni Bocci⁴, Andreina Manfredi⁵, Ennio Giulio Favalli⁶, Maria Sole Chimenti⁷, Serena Guiducci⁸, Eleonora Celletti⁹, Addolorata Corrado¹⁰, Alessandro Giollo¹¹, SIMONE PARISI¹², Ivan Giovannini¹³, Elisa Gremese¹⁴, Francesca Romana Spinelli¹⁵, Garifallia Sakellariou¹⁶, Ombretta Viapiana¹⁷ and Fabiola Atzeni¹⁸, and Cardiovascular Obesity and Rheumatic DISeases Study Group of the Italian Society of Rheumatology, ¹Rheumatology Unit DiMePRe-J, University and AOU Policlinico of Bari, Italy, Bari, Italy, ²Rheumatology Unit - University of Sassari, Sassari, Italy, ³Rheumatology Unit - Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy, ⁴Rheumatology Unit. Department of Medicine, Perugia, Perugia, Italy, ⁵University of Modena and Reggio Emilia, Modena, ⁶ASST Gaetano Pini-CTO, Milan, Lombardia, Italy, ⁷Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Roma, Italy, ⁸University of Florence, Pistoia, Italy, ⁹Medical Clinic, SS. Annunziata Hospital of Chieti, Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy, ¹⁰Rheumatology Unit, University of Foggia, Foggia, Italy, ¹¹Azienda Ospedale Università Padova, Padova, Padua, Italy, ¹²Rheumatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, TURIN, Italy, ¹³Azienda Sanitaria Universitaria Friuli Centrale, Udine, Udine, Italy, ¹⁴Catholic University of the Sacred Heart, Rome, Rome, Italy, ¹⁵Sapienza University of Rome, Rome - Italy, Roma, Rome, Italy, ¹⁶Department of Internal Medicine and Medical Therapy, University of Pavia, and Istituti Clinici Scientifici Maugeri IRCCS Pavia,, Pavia, Italy, ¹⁷Rheumatology Unit, University of Verona, Verona, Italy, ¹⁸University of Messina, Italy, Messina, Italy

Meeting: ACR Convergence 2024

Keywords: Cardiovascular, rheumatoid arthritis, risk assessment

Session Information

Date: Monday, November 18, 2024

Title: Epidemiology & Public Health Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: This study aimed to compare the performance of three validated algorithms for 10-year global cardiovascular risk stratification (GCVR): the European Systemic Coronary Risk (SCORE-2) updated in 2021 [1], the Italian “Progetto Cuore” algorithm (PCA) [2], and the Expanded Risk Score in Rheumatoid Arthritis (ERS-RA) [3] in an Italian RA population.

Methods: RA patients from a multicentre cohort, aged 40-69 years with no previous history of CV disease, were recruited in 2019 and longitudinally followed until 2023 for fatal and non-fatal CV events. Each GCVR was individually calculated at baseline using the electronic formats of the above three algorithms, multiplied by 1.5 when appropriate [4]. All patients were treated according to the “treat to target” strategy [5]. Statistical analysis was performed using STATA v.18 software with proper tests. The expected CV events were adjusted proportionally since the follow-up was less than 10 years. The performance of the algorithms was evaluated by “calibration”, expressed as standardized incidence ratios (SIR) between observed and expected events, and “discrimination”, defined as the ability of the risk function to separate high-risk from low-risk patients and expressed as the area under the receiver operator curve (AUROC), assuming that the expected rates were fixed and observed events followed a Poisson distribution.

Results: The recruited RA population (n.971; women 79.5%; mean age 57.9±7.4 years; mean disease duration 142±110 months) had a low risk of CV events globally, according to SCORE-2, PCA, and ERS-RA equations estimating a mean 10-year GCVR of 4.3%, 5% and 7.2%, respectively (see Figure). The PCA, SCORE-2, and ERS-RA predicted High CV risk in 1.7%, 2.6%, and 4.0% of patients, respectively. Examining the correlation, we observed that ERS-RA had a Pearson r of 0.79 (95%CI 0.73-0.78; p< 0.0001) compared to PCA and of 0.70 (95%CI 0.67-0.73; p< 0.0001) compared to SCORE-2. The incidence rate of fatal and non-fatal CV events was 0.25/100 patient-years. Overall, the SIR for the SCORE-2 was 0.60 (95%CI 0.32-1.11), for the PGC was 0.52 (95%CI 0.28-0.96), and for the ERS-RA was 0.36 (95%CI 0.19-0.66), indicating an overestimation of the observed CVD risk, with no statistically significant differences among the three algorithms. The discriminatory power, calculated using AUROC, was 0.611 for the PCA, 0.579 for the SCORE-2, and 0.596 for the ERS-RA.

Conclusion: The present study evaluated the prediction of GCVR in an Italian RA population for the first time by comparing three different estimating risk equations. The ERS-RA algorithm did not predict CVD risk more accurately in Italian RA patients than the CVD risk calculators developed for the general population multiplied by 1.5 as recommended by EULAR [4].

References.

1. SCORE-2 Working Group and ESC CV risk collaboration. Eur Heart J 2021;42:2439-5

2. Palmieri L, et al. Ann Ist Super Sanita. 2004;40:393-399

3. Solomon DH, et al. Arthritis Rheumatol. 2015;67:1995-2003.

4. Agca R, et al. Ann Rheum Dis. 2017;76:17-28.

5. Parisi S, et al. Reumatismo. 2019 Sep 23;71(S1):22-49.

Figure

Disclosures: F. Cacciapaglia: AbbVie/Abbott, 2, 6, Boehringer-Ingelheim, 2, 6, Eli Lilly, 6, Galapagos, 6, Janssen, 2, 6, Pfizer, 6; G. Erre: None; M. Piga: None; E. Bartoloni Bocci: None; A. Manfredi: None; E. Favalli: AbbVie, 12, Consultancy/speaker fees from, Bristol-Myers Squibb(BMS), 12, Consultancy/speaker fees from, Celltrion, 12, Consultancy/speaker fees from, Eli Lilly, 12, Consultancy/speaker fees from, Galapagos, 12, Consultancy/speaker fees from, Janssen, 12, Consultancy/speaker fees from, MSD, 12, Consultancy/speaker fees from, Novartis, 12, Consultancy/speaker fees from, Pfizer, 12, Consultancy/speaker fees from, UCB Pharma, 12, Consultancy/speaker fees from; M. Chimenti: None; S. Guiducci: None; E. Celletti: None; A. Corrado: None; A. Giollo: AbbVie/Abbott, 6, Boehringer-Ingelheim, 6, Eli Lilly, 6, UCB, 6; S. PARISI: None; I. Giovannini: None; E. Gremese: None; F. Spinelli: Abbvie, 2, 6, Eli Lilly, 6, Galapagos, 2, GlaxoSmithKlein(GSK), 6, Pfizer, 6; G. Sakellariou: None; O. Viapiana: None; F. Atzeni: None.

To cite this abstract in AMA style:

Cacciapaglia F, Erre G, Piga M, Bartoloni Bocci E, Manfredi A, Favalli E, Chimenti M, Guiducci S, Celletti E, Corrado A, Giollo A, PARISI S, Giovannini I, Gremese E, Spinelli F, Sakellariou G, Viapiana O, Atzeni F. Validation Analysis of the Expanded Risk Score for Rheumatoid Arthritis in a Multicentre Italian Cohort [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/validation-analysis-of-the-expanded-risk-score-for-rheumatoid-arthritis-in-a-multicentre-italian-cohort/. Accessed .

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-analysis-of-the-expanded-risk-score-for-rheumatoid-arthritis-in-a-multicentre-italian-cohort/