TY - JOUR
T1 - Predicting risk of cardiac events among ST-segment elevation myocardial infarction patients with conservatively managed non–infarct-related artery coronary artery disease
T2 - An analysis of the Duke Databank for Cardiovascular Disease
AU - Hirji, Sameer A.
AU - Stevens, Susanna R.
AU - Shaw, Linda K.
AU - Campbell, Erin C.
AU - Granger, Christopher B.
AU - Patel, Manesh R.
AU - Sketch, Michael H.
AU - Wang, Tracy Y.
AU - Ohman, E. Magnus
AU - Peterson, Eric D.
AU - Brennan, J. Matthew
N1 - Funding Information:
E. M. Ohman: Dr Ohman reports research grant support from Daiichi Sankyo, Eli Lilly & Company, Gilead Sciences, Janssen Pharmaceuticals (Johnson & Johnson); consulting or other services (including CME) for Faculty Connection and Medscape; and consulting or other non-CME services for Abiomed, Angel Medical, AstraZeneca, Biotie, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly & Company, Janssen Pharmaceuticals (Johnson & Johnson), Merck, Stealth Peptides, and The Medicines Company.
Funding Information:
C. B. Granger: Dr Granger reports research grant support from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, FDA, Glaxo Smith Kline, Janssen Pharmaceuticals, The Medicines Company, Medtronic Foundation, Novartis, Pfizer, Sanofi-Aventis, and Takeda, and consulting or other services (including CME) from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Gilead, Glaxo Smith Kline, Hoffmann-La Roche, Janssen Pharmaceuticals, The Medicines Company, Medtronic Inc., NIH, Novartis, Pfizer, Sanofi-Aventis, and Takeda.
Funding Information:
T. Y. Wang: Dr Wang reports research grant support from Eli Lilly, Daiichi Sankyo, Astra Zeneca; Bristol Myers Squibb, Boston Scientific, Gilead, Glaxo Smith Kline, and Regeneron, and consulting services for Eli Lilly, Astra Zeneca, and Premier.
Funding Information:
M. R. Patel: Dr Patel reports research grant support from AstraZeneca, CSL, HeartFlow, Janssen Research and Development LLC, Johnson & Johnson, MAQUET Cardiovascular LLC, Medtronic Inc., and NHLBI, and consulting or other services (including CME) from AstraZeneca, Bayer Corporation US, CSL, Genzyme Corporation, Janssen Research and Development LLC, Medtronic Inc., and Merck & Co.
Funding Information:
E. D. Peterson: Dr Peterson reports institutional grant support from the American College of Cardiology, American Heart Association, Eli Lilly, Janssen, and consulting fees (including CME) from Merck & Co, Boehringer Ingelheim, Genentech, Janssen, and Sanofi-Aventis.
Funding Information:
Dr Brennan was funded by the following grants: the Food and Drug Administration U01 , the Burroughs Wellcome Fund Innovation in Regulatory Science Award , and the Patient-Centered Outcomes Research Institute .
Funding Information:
J. M. Brennan: Dr Brennan reports support from the following grants: the Food and Drug Administration U01, the Burroughs Wellcome Fund Innovation in Regulatory Science Award, and the Patient-Centered Outcomes Research Institute.
Publisher Copyright:
© 2017
PY - 2017/12
Y1 - 2017/12
N2 - Background Recent randomized evidence has demonstrated benefit with complete revascularization during the index hospitalization for multivessel coronary artery disease ST-segment elevation myocardial infarction (STEMI) patients; however, this benefit likely depends on the risk of future major adverse cardiovascular events (MACE). Methods Using data from Duke University Medical Center (2003-2012), we identified those at high risk for 1-year MACE among 664 STEMI patients with conservatively managed non–infarct-related artery (non-IRA) lesions. Using multivariable logistic regression, we identified clinical and angiographic characteristics associated with MACE (death, myocardial infarction, urgent revascularization) to 1 year and developed an integer-based risk prediction model for clinical use. Results In this cohort (median age 60 years, 30% female), the unadjusted Kaplan-Meier rates for MACE at 30 days and 1 year were 10% and 28%, respectively. Characteristics associated with MACE at 1 year included reduced left ventricular ejection fraction, hypertension, heart failure, higher-risk non-IRA vessels (left main), renal insufficiency, and greater % stenosis of non-IRA lesions. A 15-point risk score including these variables had modest discrimination (C-index 0.67) across a spectrum of subsequent risk (4%-88%) for 1-year MACE. Conclusions There is a wide spectrum of risk following primary percutaneous coronary intervention for STEMI patients with multivessel disease. Using readily available clinical characteristics, the expected incidence of MACE by 1 year can be calculated with a simplified risk score, facilitating a tailored approach to clinical care.
AB - Background Recent randomized evidence has demonstrated benefit with complete revascularization during the index hospitalization for multivessel coronary artery disease ST-segment elevation myocardial infarction (STEMI) patients; however, this benefit likely depends on the risk of future major adverse cardiovascular events (MACE). Methods Using data from Duke University Medical Center (2003-2012), we identified those at high risk for 1-year MACE among 664 STEMI patients with conservatively managed non–infarct-related artery (non-IRA) lesions. Using multivariable logistic regression, we identified clinical and angiographic characteristics associated with MACE (death, myocardial infarction, urgent revascularization) to 1 year and developed an integer-based risk prediction model for clinical use. Results In this cohort (median age 60 years, 30% female), the unadjusted Kaplan-Meier rates for MACE at 30 days and 1 year were 10% and 28%, respectively. Characteristics associated with MACE at 1 year included reduced left ventricular ejection fraction, hypertension, heart failure, higher-risk non-IRA vessels (left main), renal insufficiency, and greater % stenosis of non-IRA lesions. A 15-point risk score including these variables had modest discrimination (C-index 0.67) across a spectrum of subsequent risk (4%-88%) for 1-year MACE. Conclusions There is a wide spectrum of risk following primary percutaneous coronary intervention for STEMI patients with multivessel disease. Using readily available clinical characteristics, the expected incidence of MACE by 1 year can be calculated with a simplified risk score, facilitating a tailored approach to clinical care.
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U2 - 10.1016/j.ahj.2017.08.023
DO - 10.1016/j.ahj.2017.08.023
M3 - Article
C2 - 29223429
AN - SCOPUS:85031109499
VL - 194
SP - 116
EP - 124
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -