Validation of the SMART-REACH model after stroke and the effect
of colchicine by atherosclerotic cardiovascular disease risk
category: a secondary analysis of the CONVINCE randomised
clinical trial

J 2026

Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial

MAES, Louise; Claudia VERSCHUERE; Cathal WALSH; Christian WEIMAR; Francisco PURROY et al.

Základní údaje

Originální název

Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial

Autoři

Vydání

EUROPEAN STROKE JOURNAL, LONDON, SAGE PUBLICATIONS LTD, 2026, 2396-9873

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30210 Clinical neurology

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 4.500 v roce 2024

Označené pro přenos do RIV

Ano

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

colchicine; stroke; transient ischaemic attack; atherosclerotic cardiovascular disease; risk factors; risk estimation; secondary prevention

Štítky

14110127, 14110132, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 8. 6. 2026 13:19, Mgr. Tereza Miškechová

Anotace

V originále

Introduction The Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) trial showed that recurrent events were significantly reduced among colchicine-adherent non-cardioembolic stroke patients in the on-treatment analysis. This study aimed to validate the SMART-REACH risk score in stroke patients, and to determine whether colchicine's efficacy varies by baseline atherosclerotic cardiovascular disease (ASCVD) risk. Patients and methods Patients with non-severe non-cardioembolic ischaemic stroke/transient ischaemic attack (TIA) were randomised to colchicine 0.5 mg plus usual care or usual care alone. Participants were stratified into moderate (10%-19%), high (20%-30%) and very high (>= 30%) 10-year ASCVD risk categories using the SMART-REACH model. Model performance was assessed using the C-statistic and calibration plots. The primary endpoint (major adverse cardiovascular events [MACE]) was a composite of fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest or hospitalisation for unstable angina. Results Among 3144 patients, MACE incidence significantly increased with ASCVD risk levels: 7.2% (moderate), 8.8% (high) and 13.8% (very high) (P < .01). The C-statistic for 3-year risk of MACE was 0.59 (95% CI, 0.56-0.63). While no statistically significant treatment interaction was found (P = .88), absolute risk reductions (ARRs) were more pronounced in higher-risk groups: moderate risk 7.2% (colchicine) vs 7.2% (usual care) (hazard ratio [HR] 1.01; 95% CI, 0.55-1.83); high risk 7.7% vs 9.8% (ARR 2.1%; HR 0.79; 95% CI, 0.53-1.18); very high risk 12.5% vs 15.2% (ARR 2.7%; HR 0.85; 95% CI, 0.64-1.12). Discussion and Conclusion We identified an association between very high baseline ASCVD risk (>= 30%) assigned by the SMART-REACH score and increased recurrent MACE. Although no significant treatment interaction was observed, patients in higher risk categories may represent a more promising target population for secondary prevention with colchicine.

Citovat

MAES, Louise; Claudia VERSCHUERE; Cathal WALSH; Christian WEIMAR; Francisco PURROY; Christopher PRICE; Catarina FONSECA; Michael D HILL; Dalius JATUZIS; Janika KORV; Christina KRUUSE; Robert MIKULÍK; Paul NEDERKOORN; Anna CZLONKOWSKA; Urs FISCHER; Michael MCCORMICK; Maria CASTELLANOS; Miguel BAPTISTA; Joao Pedro MARTO; Kamy THAVANESAN; David J WILLIAMS; Peter KELLY a Robin LEMMENS. Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial. EUROPEAN STROKE JOURNAL. LONDON: SAGE PUBLICATIONS LTD, 2026, roč. 11, č. 4, s. 1-11. ISSN 2396-9873. Dostupné z: https://doi.org/10.1093/esj/aakag033.

@article{2577704,
   author = {Maes, Louise and Verschuere, Claudia and Walsh, Cathal and Weimar, Christian and Purroy, Francisco and Price, Christopher and Fonseca, Catarina and Hill, Michael D and Jatuzis, Dalius and Korv, Janika and Kruuse, Christina and Mikulík, Robert and Nederkoorn, Paul and Czlonkowska, Anna and Fischer, Urs and McCormick, Michael and Castellanos, Maria and Baptista, Miguel and Marto, Joao Pedro and Thavanesan, Kamy and Williams, David J and Kelly, Peter and Lemmens, Robin},
   article_location = {LONDON},
   article_number = {4},
   doi = {https://doi.org/10.1093/esj/aakag033},
   keywords = {colchicine; stroke; transient ischaemic attack; atherosclerotic cardiovascular disease; risk factors; risk estimation; secondary prevention},
   language = {eng},
   issn = {2396-9873},
   journal = {EUROPEAN STROKE JOURNAL},
   title = {Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial},
   url = {https://academic.oup.com/esj/article/11/4/aakag033/8662275},
   volume = {11},
   year = {2026}
}

TY  - JOUR
ID  - 2577704
AU  - Maes, Louise - Verschuere, Claudia - Walsh, Cathal - Weimar, Christian - Purroy, Francisco - Price, Christopher - Fonseca, Catarina - Hill, Michael D - Jatuzis, Dalius - Korv, Janika - Kruuse, Christina - Mikulík, Robert - Nederkoorn, Paul - Czlonkowska, Anna - Fischer, Urs - McCormick, Michael - Castellanos, Maria - Baptista, Miguel - Marto, Joao Pedro - Thavanesan, Kamy - Williams, David J - Kelly, Peter - Lemmens, Robin
PY  - 2026
TI  - Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial
JF  - EUROPEAN STROKE JOURNAL
VL  - 11
IS  - 4
SP  - 1-11
EP  - 1-11
PB  - SAGE PUBLICATIONS LTD
SN  - 23969873
KW  - colchicine
KW  - stroke
KW  - transient ischaemic attack
KW  - atherosclerotic cardiovascular disease
KW  - risk factors
KW  - risk estimation
KW  - secondary prevention
UR  - https://academic.oup.com/esj/article/11/4/aakag033/8662275
N2  - Introduction The Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) trial showed that recurrent events were significantly reduced among colchicine-adherent non-cardioembolic stroke patients in the on-treatment analysis. This study aimed to validate the SMART-REACH risk score in stroke patients, and to determine whether colchicine's efficacy varies by baseline atherosclerotic cardiovascular disease (ASCVD) risk. Patients and methods Patients with non-severe non-cardioembolic ischaemic stroke/transient ischaemic attack (TIA) were randomised to colchicine 0.5 mg plus usual care or usual care alone. Participants were stratified into moderate (10%-19%), high (20%-30%) and very high (>= 30%) 10-year ASCVD risk categories using the SMART-REACH model. Model performance was assessed using the C-statistic and calibration plots. The primary endpoint (major adverse cardiovascular events [MACE]) was a composite of fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest or hospitalisation for unstable angina. Results Among 3144 patients, MACE incidence significantly increased with ASCVD risk levels: 7.2% (moderate), 8.8% (high) and 13.8% (very high) (P < .01). The C-statistic for 3-year risk of MACE was 0.59 (95% CI, 0.56-0.63). While no statistically significant treatment interaction was found (P = .88), absolute risk reductions (ARRs) were more pronounced in higher-risk groups: moderate risk 7.2% (colchicine) vs 7.2% (usual care) (hazard ratio [HR] 1.01; 95% CI, 0.55-1.83); high risk 7.7% vs 9.8% (ARR 2.1%; HR 0.79; 95% CI, 0.53-1.18); very high risk 12.5% vs 15.2% (ARR 2.7%; HR 0.85; 95% CI, 0.64-1.12). Discussion and Conclusion We identified an association between very high baseline ASCVD risk (>= 30%) assigned by the SMART-REACH score and increased recurrent MACE. Although no significant treatment interaction was observed, patients in higher risk categories may represent a more promising target population for secondary prevention with colchicine.
ER  -

MAES, Louise; Claudia VERSCHUERE; Cathal WALSH; Christian WEIMAR; Francisco PURROY; Christopher PRICE; Catarina FONSECA; Michael D HILL; Dalius JATUZIS; Janika KORV; Christina KRUUSE; Robert MIKULÍK; Paul NEDERKOORN; Anna CZLONKOWSKA; Urs FISCHER; Michael MCCORMICK; Maria CASTELLANOS; Miguel BAPTISTA; Joao Pedro MARTO; Kamy THAVANESAN; David J WILLIAMS; Peter KELLY a Robin LEMMENS. Validation of the SMART-REACH model after stroke and the effect of colchicine by atherosclerotic cardiovascular disease risk category: a secondary analysis of the CONVINCE randomised clinical trial. \textit{EUROPEAN STROKE JOURNAL}. LONDON: SAGE PUBLICATIONS LTD, 2026, roč.~11, č.~4, s.~1-11. ISSN~2396-9873. Dostupné z: https://doi.org/10.1093/esj/aakag033.

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