Improving Risk Stratification for Patients with Type 2 Myocardial Infarction

Caelan Taggart; Karla Monterrubio-Gomez; Andreas Roos; Jasper Boeddinghaus; Dorien Kimenai; Erik Kadesjo; Anda Bularga; Ryan Wereski; Amy Ferry; Matthew Lowry; Atul Anand; Kuan Ken Lee; Dimitrios Doudesis; Ioanna Manolopoulou; Thomas Nestelberger; Luca Koechlin; Pedro Lopez-Ayala; Christian Mueller; Nicholas L Mills; Catalina A Vallejos; Andrew R Chapman

doi:10.1016/j.jacc.2022.10.025

Improving Risk Stratification for Patients with Type 2 Myocardial Infarction

Caelan Taggart^*, Karla Monterrubio-Gomez^*, Andreas Roos, Jasper Boeddinghaus, Dorien Kimenai, Erik Kadesjo, Anda Bularga, Ryan Wereski, Amy Ferry, Matthew Lowry, Atul Anand, Kuan Ken Lee, Dimitrios Doudesis, Ioanna Manolopoulou, Thomas Nestelberger, Luca Koechlin, Pedro Lopez-Ayala, Christian Mueller , Nicholas L Mills, Catalina A VallejosAndrew R Chapman

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background
Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.

Objectives
The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.

Methods
The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.

Results
There were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.

Conclusions
The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123)

Original language	English
Pages (from-to)	156-168
Journal	Journal of the American College of Cardiology
Volume	81
Issue number	2
Early online date	9 Jan 2023
DOIs	https://doi.org/10.1016/j.jacc.2022.10.025
Publication status	Published - 17 Jan 2023

Keywords / Materials (for Non-textual outputs)

risk prediction
type 2 myocardial infarction

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Taggart, C., Monterrubio-Gomez, K., Roos, A., Boeddinghaus, J., Kimenai, D., Kadesjo, E., Bularga, A., Wereski, R., Ferry, A., Lowry, M., Anand, A., Lee, K. K., Doudesis, D., Manolopoulou, I., Nestelberger, T., Koechlin, L., Lopez-Ayala, P., Mueller , C., Mills, N. L., ... Chapman, A. R. (2023). Improving Risk Stratification for Patients with Type 2 Myocardial Infarction. Journal of the American College of Cardiology, 81(2), 156-168. https://doi.org/10.1016/j.jacc.2022.10.025

@article{b6b78c0256694cb383044f9574947ed7,

title = "Improving Risk Stratification for Patients with Type 2 Myocardial Infarction",

abstract = "BackgroundDespite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.ObjectivesThe goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.MethodsThe T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.ResultsThere were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.ConclusionsThe T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123)",

keywords = "risk prediction, type 2 myocardial infarction",

author = "Caelan Taggart and Karla Monterrubio-Gomez and Andreas Roos and Jasper Boeddinghaus and Dorien Kimenai and Erik Kadesjo and Anda Bularga and Ryan Wereski and Amy Ferry and Matthew Lowry and Atul Anand and Lee, {Kuan Ken} and Dimitrios Doudesis and Ioanna Manolopoulou and Thomas Nestelberger and Luca Koechlin and Pedro Lopez-Ayala and Christian Mueller and Mills, {Nicholas L} and Vallejos, {Catalina A} and Chapman, {Andrew R}",

note = "Funding Information: The High-STEACS (High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome) trial makes use of several routine electronic health care data sources that are linked, de-identified, and held in our Safe Haven, which is accessible by approved individuals who have undertaken the necessary governance training. The analysis code is made available to enable replication at https://github.com/KarlaMonterrubioG/T2-risk-score. The High-STEACS Investigators contributed to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work. They were involved in drafting and revising the article and have given final approval of the version to be published. The High-STEACS investigators are accountable for the work. The authors thank researchers from the Emergency Medicine Research Group Edinburgh for their support during the conduct of this trial. The authors dedicate this paper to the memory of Prof Martin J. Holzmann, who was integral to the development of this project, and both a valued colleague and friend. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = jan,

day = "17",

doi = "10.1016/j.jacc.2022.10.025",

language = "English",

volume = "81",

pages = "156--168",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "ELSEVIER SCIENCE INC",

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Taggart, C, Monterrubio-Gomez, K, Roos, A, Boeddinghaus, J, Kimenai, D, Kadesjo, E, Bularga, A, Wereski, R , Ferry, A, Lowry, M, Anand, A, Lee, KK, Doudesis, D, Manolopoulou, I, Nestelberger, T, Koechlin, L, Lopez-Ayala, P, Mueller , C, Mills, NL , Vallejos, CA & Chapman, AR 2023, 'Improving Risk Stratification for Patients with Type 2 Myocardial Infarction', Journal of the American College of Cardiology, vol. 81, no. 2, pp. 156-168. https://doi.org/10.1016/j.jacc.2022.10.025

TY - JOUR

T1 - Improving Risk Stratification for Patients with Type 2 Myocardial Infarction

AU - Taggart, Caelan

AU - Monterrubio-Gomez, Karla

AU - Roos, Andreas

AU - Boeddinghaus, Jasper

AU - Kimenai, Dorien

AU - Kadesjo, Erik

AU - Bularga, Anda

AU - Wereski, Ryan

AU - Ferry, Amy

AU - Lowry, Matthew

AU - Anand, Atul

AU - Lee, Kuan Ken

AU - Doudesis, Dimitrios

AU - Manolopoulou, Ioanna

AU - Nestelberger, Thomas

AU - Koechlin, Luca

AU - Lopez-Ayala, Pedro

AU - Mueller , Christian

AU - Mills, Nicholas L

AU - Vallejos, Catalina A

AU - Chapman, Andrew R

N1 - Funding Information: The High-STEACS (High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome) trial makes use of several routine electronic health care data sources that are linked, de-identified, and held in our Safe Haven, which is accessible by approved individuals who have undertaken the necessary governance training. The analysis code is made available to enable replication at https://github.com/KarlaMonterrubioG/T2-risk-score. The High-STEACS Investigators contributed to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work. They were involved in drafting and revising the article and have given final approval of the version to be published. The High-STEACS investigators are accountable for the work. The authors thank researchers from the Emergency Medicine Research Group Edinburgh for their support during the conduct of this trial. The authors dedicate this paper to the memory of Prof Martin J. Holzmann, who was integral to the development of this project, and both a valued colleague and friend. Publisher Copyright: © 2023 The Authors

PY - 2023/1/17

Y1 - 2023/1/17

N2 - BackgroundDespite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.ObjectivesThe goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.MethodsThe T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.ResultsThere were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.ConclusionsThe T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123)

AB - BackgroundDespite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction.ObjectivesThe goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction.MethodsThe T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe.ResultsThere were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts.ConclusionsThe T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123)

KW - risk prediction

KW - type 2 myocardial infarction

U2 - 10.1016/j.jacc.2022.10.025

DO - 10.1016/j.jacc.2022.10.025

M3 - Article

SN - 0735-1097

VL - 81

SP - 156

EP - 168

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 2

ER -

Improving Risk Stratification for Patients with Type 2 Myocardial Infarction

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Keywords / Materials (for Non-textual outputs)

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