Pocock, Stuart J; Brieger, David; Gregson, John; Chen, Ji Y; Cohen, Mauricio G; Goodman, Shaun G; Granger, Christopher B; Grieve, Richard; Nicolau, Jose C; Simon, Tabassome; +6 more... Westermann, Dirk; Yasuda, Satoshi; Hedman, Katarina; Rennie, Kirsten L; Sundell, Karolina Andersson; TIGRIS Study Investigators; (2019) Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry. Clinical cardiology, 43 (1). pp. 24-32. ISSN 0160-9289 DOI: https://doi.org/10.1002/clc.23283
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Abstract
BACKGROUND: Risk prediction tools are lacking for patients with stable disease some years after myocardial infarction (MI). HYPOTHESIS: A practical long-term cardiovascular risk index can be developed. METHODS: The long-Term rIsk, Clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients prospective global registry enrolled patients 1 to 3 years post-MI (369 centers; 25 countries), all with ≥1 risk factor (age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, or chronic non-end-stage kidney disease [CKD]). Self-reported health was assessed with EuroQoL-5 dimensions. Multivariable Poisson regression models were used to determine key predictors of the primary composite outcome (MI, unstable angina with urgent revascularization [UA], stroke, or all-cause death) over 2 years. RESULTS: The primary outcome occurred in 621 (6.9%) of 9027 eligible patients: death 295 (3.3%), MI 195 (2.2%), UA 103 (1.1%), and stroke 58 (0.6%). All events accrued linearly. In a multivariable model, 11 significant predictors of primary outcome (age ≥65 years, diabetes, second prior MI, CKD, history of major bleed, peripheral arterial disease, heart failure, cardiovascular hospitalization (prior 6 months), medical management (index MI), on diuretic, and poor self-reported health) were identified and combined into a user-friendly risk index. Compared with lowest-risk patients, those in the top 16% had a rate ratio of 6.9 for the primary composite, and 18.7 for all-cause death (overall c-statistic; 0.686, and 0.768, respectively). External validation was performed using the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events registry (c-statistic; 0.748, and 0.849, respectively). CONCLUSIONS: In patients >1-year post-MI, recurrent cardiovascular events and deaths accrue linearly. A simple risk index can stratify patients, potentially helping to guide management.
Item Type | Article |
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Faculty and Department |
Faculty of Epidemiology and Population Health > Dept of Medical Statistics Faculty of Public Health and Policy > Dept of Health Services Research and Policy |
PubMed ID | 31713893 |
Elements ID | 141520 |
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