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Risk Factors Associated With Cardiovascular Events After AMI
Study Questions:
What are the risk factors associated with major cardiovascular events within 1 year among patients who survive an acute myocardial infarction (AMI)?
Methods:
The investigators conducted a prospective cohort study of patients with AMI (nā=ā4,227), aged ā„18 years, discharged alive from 53 acute care hospitals across China from January 1, 2013, to July 17, 2014. Patients were randomly divided into samples: training (50% [2,113 patients]), test (25% [1,057 patients]), and validation (25% [1,057 patients]). Risk factors were identified by a Cox model with Markov chain Monte Carlo simulation, and further evaluated by latent class analysis. Analyses were conducted from May 1, 2017, to January 21, 2018. The main outcome measures were major cardiovascular events, including recurrent AMI, stroke, heart failure, and death within 1 year after discharge for the index AMI hospitalization.
Results:
The mean (standard deviation) age of the cohort was 60.8 (11.8) years, and 994 of 4,227 patients (23.5%) were female. Common comorbidities included hypertension (2,358 patients [55.8%]), coronary heart disease (1,798 patients [42.5%]), and dyslipidemia (1,290 patients [30.5%]). One-year event rates were 8.1% (95% confidence interval [CI], 6.91%-9.24%), 9.0% (95% CI, 7.22%-10.70%), and 6.4% (95% CI, 4.89%-7.85%) for the training, test, and validation samples, respectively. Nineteen risk factors comprising 15 unique variables (age, education, prior AMI, prior ventricular tachycardia or fibrillation, hypertension, angina, prearrival medical assistance, >4 hours from onset of symptoms to admission, ejection fraction, renal dysfunction, heart rate, systolic blood pressure, white blood cell count, blood glucose, and in-hospital complications) were identified. In the training, test, and validation samples, respectively, the risk model had C statistics of 0.79 (95% CI, 0.75-0.83), 0.73 (95% CI, 0.68-0.78), and 0.77 (95% CI, 0.70-0.83) and a predictive range of 1.2% to 33.9%, 1.2% to 37.9%, and 1.3% to 34.3%. The C statistic was 0.69 (95% CI, 0.65-0.74) for the latent class model in the training data. The risk model stratified 11.3%, 81.0%, and 7.7% of patients to high-, average-, and low-risk groups, with respective probabilities of 0.32, 0.06, and 0.01 for 1-year events.
Conclusions:
The authors concluded that a 19-factor risk model has good predictive range and is able to identify high-risk AMI patients at the time of discharge.
Perspective:
This prospective cohort study identified easy to collect 19 risk factors (age, education, prior AMI, prior ventricular tachycardia or fibrillation, hypertension, angina, prearrival medical assistance, >4 hours from onset of symptoms to admission, ejection fraction, renal dysfunction, heart rate, systolic blood pressure, white blood cell count, blood glucose, and in-hospital complications) and developed and evaluated a risk model that predicts 1-year major cardiovascular events after discharge for AMI. The risk model may allow clinicians to identify patients who are at heightened risk of 1-year cardiovascular events, and might also help patients understand their risk of not only death, but also adverse events that could impair their quality of life. The ability to identify individuals with the highest risk of long-term cardiovascular events after AMI may also aid in the provision of targeted, intensive, more frequent, and higher-quality longitudinal care following discharge.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Acute Heart Failure, Hypertension
Keywords: Acute Coronary Syndrome, Angina Pectoris, Blood Glucose, Blood Pressure, Coronary Disease, Dyslipidemias, Stroke Volume, Heart Failure, Hypertension, Primary Prevention, Renal Insufficiency, Risk Factors, Stroke, Tachycardia, Ventricular, Ventricular Fibrillation
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