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Improving Risk Stratification for Patients With Type 2 MI
Quick Takes
- T2-risk score was developed and validated to prognosticate outcomes (subsequent MI and death from any cause or death from cardiovascular disease at 1 year) using clinical variables among patients with Type 2 MI.
- Variables used included age, history of ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration.
- T2-risk offers the potential to identify high-risk patients with Type 2 MI within a heterogenous group of patients.
Study Questions:
Can a risk stratification tool for the prediction of death or future myocardial infarction (MI) in patients with type 2 MI be derived and validated?
Methods:
The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 MI. Cox proportional hazards models were constructed for the primary outcome of MI 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.
Results:
There 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% confidence interval [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.
Conclusions:
The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventive therapies more effectively.
Perspective:
The authors developed and validated a risk score to prognosticate outcomes (subsequent MI and death from any cause or death from cardiovascular disease at 1 year) using clinical variables (age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration) among patients with Type 2 MI. T2-risk score had good discrimination and outperformed the GRACE 2.0 risk score. It offers the potential to identify high-risk patients with type 2 MI within this heterogenous group of patients. Challenges of optimal therapy for these patients remain; however, identifying the highest risk patients could help target specific therapies in an effort to improve clinical outcomes.
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Anemia, Area Under Curve, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Electrocardiography, Glomerular Filtration Rate, Heart Failure, Myocardial Infarction, Myocardial Ischemia, Primary Prevention, Risk Assessment, Troponin
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