Predicting risk of cardiac events among ST-segment elevation myocardial infarction patients with conservatively managed non–infarct-related artery coronary artery disease: An analysis of the Duke Databank for Cardiovascular Disease

Sameer A. Hirji, Susanna R. Stevens, Linda K. Shaw, Erin C. Campbell, Christopher B. Granger, Manesh R. Patel, Michael H. Sketch, Tracy Y. Wang, E. Magnus Ohman, Eric D. Peterson, J. Matthew Brennan

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)116-124
Number of pages9
JournalAmerican heart journal
Volume194
DOIs
StatePublished - Dec 2017
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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