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Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk
OBJECTIVE: Post-myocardial infarction (MI) care is crucial to preventing recurrent major adverse cardiovascular events (MACE), but can be complicated to personalise. A tool is needed that effectively stratifies risk of cardiovascular (CV) events 1–3 years after MI but is also clinically usable. METH...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845421/ https://www.ncbi.nlm.nih.gov/pubmed/29531761 http://dx.doi.org/10.1136/openhrt-2017-000723 |
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author | Horne, Benjamin D Muhlestein, Joseph B Bhandary, Durgesh Hoetzer, Greta L Khan, Naeem D Bair, Tami L Lappé, Donald L |
author_facet | Horne, Benjamin D Muhlestein, Joseph B Bhandary, Durgesh Hoetzer, Greta L Khan, Naeem D Bair, Tami L Lappé, Donald L |
author_sort | Horne, Benjamin D |
collection | PubMed |
description | OBJECTIVE: Post-myocardial infarction (MI) care is crucial to preventing recurrent major adverse cardiovascular events (MACE), but can be complicated to personalise. A tool is needed that effectively stratifies risk of cardiovascular (CV) events 1–3 years after MI but is also clinically usable. METHODS: Patients surviving ≥1 year after an index MI with ≥1 risk factor for recurrent MI (ie, age ≥65 years, prior MI, multivessel coronary disease, diabetes, glomerular filtration rate <60 mL/min/1.73 m(2)) were studied. Cox regression derived sex-specific Intermountain Major Adverse Cardiovascular Events (IMACE) risk scores for the composite of 1-year to 3-year MACE (CV death, MI or stroke). Derivation was performed in 70% of subjects (n=1342 women; 3047 men), with validation in the other 30% (n=576 women; 1290 men). Secondary validations were also performed. RESULTS: In women, predictors of CV events were glucose, creatinine, haemoglobin, platelet count, red cell distribution width (RDW), age and B-type natriuretic peptide (BNP); among men, they were potassium, glucose, blood urea nitrogen, haematocrit, white blood cell count, RDW, mean platelet volume, age and BNP. In the primary validation, in women, IMACE ranged from 0 to 11 (maximum possible: 12) and had HR=1.44 per +1 score (95% CI 1.29 to 1.61; P<0.001); men had IMACE range 0–14 (maximum: 16) and HR=1.29 per +1 score (95% CI 1.20 to 1.38; P<0.001). IMACE ≥5 in women (≥6 in men) showed strikingly higher MACE risk. CONCLUSIONS: Sex-specific risk scores strongly stratified 1-year to 3-year post-MI MACE risk. IMACE is an inexpensive, dynamic, electronically delivered tool for evaluating and better managing post-MI patient care. |
format | Online Article Text |
id | pubmed-5845421 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58454212018-03-12 Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk Horne, Benjamin D Muhlestein, Joseph B Bhandary, Durgesh Hoetzer, Greta L Khan, Naeem D Bair, Tami L Lappé, Donald L Open Heart Basic and Translational Research OBJECTIVE: Post-myocardial infarction (MI) care is crucial to preventing recurrent major adverse cardiovascular events (MACE), but can be complicated to personalise. A tool is needed that effectively stratifies risk of cardiovascular (CV) events 1–3 years after MI but is also clinically usable. METHODS: Patients surviving ≥1 year after an index MI with ≥1 risk factor for recurrent MI (ie, age ≥65 years, prior MI, multivessel coronary disease, diabetes, glomerular filtration rate <60 mL/min/1.73 m(2)) were studied. Cox regression derived sex-specific Intermountain Major Adverse Cardiovascular Events (IMACE) risk scores for the composite of 1-year to 3-year MACE (CV death, MI or stroke). Derivation was performed in 70% of subjects (n=1342 women; 3047 men), with validation in the other 30% (n=576 women; 1290 men). Secondary validations were also performed. RESULTS: In women, predictors of CV events were glucose, creatinine, haemoglobin, platelet count, red cell distribution width (RDW), age and B-type natriuretic peptide (BNP); among men, they were potassium, glucose, blood urea nitrogen, haematocrit, white blood cell count, RDW, mean platelet volume, age and BNP. In the primary validation, in women, IMACE ranged from 0 to 11 (maximum possible: 12) and had HR=1.44 per +1 score (95% CI 1.29 to 1.61; P<0.001); men had IMACE range 0–14 (maximum: 16) and HR=1.29 per +1 score (95% CI 1.20 to 1.38; P<0.001). IMACE ≥5 in women (≥6 in men) showed strikingly higher MACE risk. CONCLUSIONS: Sex-specific risk scores strongly stratified 1-year to 3-year post-MI MACE risk. IMACE is an inexpensive, dynamic, electronically delivered tool for evaluating and better managing post-MI patient care. BMJ Publishing Group 2018-02-20 /pmc/articles/PMC5845421/ /pubmed/29531761 http://dx.doi.org/10.1136/openhrt-2017-000723 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Basic and Translational Research Horne, Benjamin D Muhlestein, Joseph B Bhandary, Durgesh Hoetzer, Greta L Khan, Naeem D Bair, Tami L Lappé, Donald L Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title | Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title_full | Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title_fullStr | Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title_full_unstemmed | Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title_short | Clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
title_sort | clinically feasible stratification of 1-year to 3-year post-myocardial infarction risk |
topic | Basic and Translational Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845421/ https://www.ncbi.nlm.nih.gov/pubmed/29531761 http://dx.doi.org/10.1136/openhrt-2017-000723 |
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