The following is a summary of “Improving Risk Stratification for Patients With Type 2 Myocardial Infarction,” published in the January 2023 issue of Cardiology by Taggart, et al.
Despite poor cardiovascular outcomes, specific, proven risk classification techniques did not support type 2 myocardial infarction investigation and therapy. For a study, researchers sought to develop and verify a risk stratification tool for patients with type 2 myocardial infarction to predict their mortality or subsequent myocardial infarction.
The prospective multicenter cohort of individuals with type 2 myocardial infarction was used to establish the T2-risk score. Using variables predetermined based on clinical relevance, Cox proportional hazards models were built for the primary outcome of myocardial infarction or death at 1 year. The area under the receiving-operating characteristic curve (AUC) was used to measure discrimination. A graphic investigation was done into calibration. The instrument was validated in a multicenter cohort study from sites across Europe and a single-center cohort of consecutive patients.
The primary outcome occurred in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively, in the derivation, single-center, and multicenter validation cohorts. There were 1,121, 250, and 253 patients in each cohort. Age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration were all included in the T2-risk score, which was also well calibrated. The T2-risk score had good discrimination for the primary outcome (AUC: 0.76; 95% CI: 0.73-0.79). The degree of discrimination was comparable between the sequential patient cohort (AUC: 0.83; 95% CI: 0.77-0.88) and the multicenter cohort (AUC: 0.74; 95% CI: 0.64-0.83). In comparison to the Global Registry of Acute Coronary Events, T2-risk offered better discrimination. In all cohorts, the risk score was 2.0.
The T2-risk score worked well in various healthcare environments and might aid physicians in prognostication and more efficiently focus research and preventative medicines.
Reference: jacc.org/doi/10.1016/j.jacc.2022.10.025