Improving Risk Stratification for Patients With Type 2 Myocardial Infarction |
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| Institution: | 1. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom;2. MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom;3. Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden;4. Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden;5. Department of Medicine, Karolinska Institute, Stockholm, Sweden;6. Usher Institute, University of Edinburgh, Edinburgh, United Kingdom;7. Department of Statistical Sciences, University College London, London, United Kingdom;8. Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland;9. The Alan Turing Institute, London, United Kingdom |
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| Abstract: | BackgroundDespite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.ObjectivesThe goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.MethodsThe T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.ResultsThere were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.ConclusionsThe T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome High-STEACS]; NCT01852123) |
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| Keywords: | risk prediction type 2 myocardial infarction AUC"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"area under the receiving-operating characteristic curve GRACE"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"Global Registry of Acute Coronary Events hs-cTnI"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"high-sensitivity cardiac troponin I hs-cTnT"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"high-sensitivity cardiac troponin T ICD-10"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"International Classification of Diseases-10th Revision TIMI"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"Thrombolysis In Myocardial Infarction |
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