Author + information
- Giancarlo Silvio Marenzi,
- Nicola Cosentino,
- Jeness Campodonico,
- Valentina Milazzo,
- Monica De Metrio,
- Mara Rubino and
- Pompilio Faggiano
Background: Patients with acute myocardial infarction (AMI) are at high risk for death and recurrent ischemic events after hospital discharge. The PEGASUS-TIMI 54 trial showed that the addition of ticagrelor to low-dose aspirin reduces long-term ischemic risk in patients with a history of AMI, with ≥50 years, and with at least one additional feature (age ≥65 years, diabetes, prior AMI, multi-vessel coronary disease, and GFR <60 ml/min). This reduction was accompanied by an increase in major bleeding, so that identification of patients who may benefit from a long-term dual antiplatelet therapy remains a critical issue. Notably, these criteria can be easily collected during AMI hospitalization. Moreover, as they encompass most AMI patients, an effort for further risk stratification should be performed
Methods: We elaborated a risk score to predict 1-year mortality and re-AMI (primary end point) in AMI patients, using the PEGASUS-TIMI 54 criteria. We evaluated the hazard ratios (HR) for the primary end point of each criterion, and converted them to the nearest integer number; the sum of the integers gave a value of risk score. We calculated a cut-off value for the score, able to maximize sum of sensitivity and specificity, and investigated its 1-year prognostic power.
Results: We included 1,324 AMI patients. Of them, 997 (75%) had ≥1 PEGASUS criterion. The primary end point increased in parallel with the number of criteria presents in a single patient (3%, 3%, 7%, 13%, 16% and 20%, going from 0 to 5, respectively). At multivariate analysis for the primary end point prediction, a weighted risk score of 13 was obtained by using these criteria. At ROC analysis, the risk score cut-off maximizing sensitivity and specificity was ≥6. The primary end point was significantly higher in patients with a score ≥6 than in those with a score <6 (13.5% vs. 4%, P<0.0001). At multivariate analysis, the HR of a score ≥6 for the primary end point prediction was 3.80 (95% CI 2.50-5.79; P<0.0001).
Conclusions: In AMI patients, a risk score developed by using the PEGASUS-TIMI 54 criteria can accurately identify those at highest risk for death and recurrent AMI. A validation of this score in a different cohort of AMI patients is currently ongoing.
Moderated Poster Contributions
Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:45 a.m.-11:55 a.m.
Session Title: Post-CAD/MI: Making Tough Predictions About the Future
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1138M-17
- 2017 American College of Cardiology Foundation