External Validation and Head-to-Head Comparison of Cuore and Score2 Cardiovascular Risk Scores in an Italian Primary Care-Administrative Cohort

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ID: 320529
2026
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Abstract
Abstract Aims To externally validate and compare CUORE and SCORE2 for 10-year prediction of first fatal or non-fatal myocardial infarction or stroke in an Italian primary care cohort, and to quantify the impact of administrative endpoint definition and model recalibration. Methods and results We studied 38,101 adults in ATS Milan (baseline 2007-2009) with primary care risk factors linked to hospital discharge and mortality registries for 10-year follow-up. The endpoint was first fatal or non-fatal myocardial infarction or stroke, ascertained using a strict (primary diagnosis/procedure fields) and a broad (any diagnosis/procedure field) administrative definition. Discrimination was assessed with IPCW time-dependent AUC and calibration with decile plots, calibration-in-the-large and calibration slope, comparing uncalibrated and recalibrated implementations. SCORE2 AUC ranged 0.713-0.720, whereas CUORE ranged 0.730-0.741. Broad ascertainment increased event rates (SCORE2: 5.6% vs 4.4%; CUORE: 6.8% vs 5.0%) without materially changing AUC. SCORE2 showed more stable calibration, whereas CUORE showed calibration slopes <1. Conclusion In this real-world Italian cohort, CUORE and SCORE2 provided robust ordinal risk stratification and moderate discrimination at 10 years. Absolute risk estimates were sensitive to administrative endpoint mapping and recalibration strategy, supporting transparent endpoint reporting and local calibration assessment before applying risk thresholds in practice.
Reference Key
openalex_W7167972275 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Alberto Milanese, Antonio Russo
Journal european journal of preventive cardiology
Year 2026
DOI
10.1093/eurjpc/zwag361
URL
https://doi.org/10.1093/eurjpc/zwag361
Keywords Keywords not found

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