Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry

for the TIGRIS Study Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Registries
Myocardial Infarction
Coronary Artery Disease
Cause of Death
Stroke
Guideline Adherence
Peripheral Arterial Disease
Unstable Angina
Health
Risk Management
Kidney Diseases
Diuretics
Diabetes Mellitus
Hospitalization
Heart Failure
Delivery of Health Care

Keywords

  • cardiac risk factors and prevention
  • coronary artery disease
  • myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry. / for the TIGRIS Study Investigators.

In: Clinical Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry",
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.",
keywords = "cardiac risk factors and prevention, coronary artery disease, myocardial infarction",
author = "{for the TIGRIS Study Investigators} and Pocock, {Stuart J.} and David Brieger and John Gregson and Chen, {Ji Y.} and Cohen, {Mauricio G.} and Goodman, {Shaun G.} and Granger, {Christopher B.} and Richard Grieve and Nicolau, {Jose C.} and Tabassome Simon and Dirk Westermann and Satoshi Yasuda and Katarina Hedman and Rennie, {Kirsten L.} and Sundell, {Karolina Andersson}",
year = "2019",
month = "1",
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doi = "10.1002/clc.23283",
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journal = "Clinical Cardiology",
issn = "0160-9289",
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T1 - Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry

AU - for the TIGRIS Study Investigators

AU - Pocock, Stuart J.

AU - Brieger, David

AU - Gregson, John

AU - Chen, Ji Y.

AU - Cohen, Mauricio G.

AU - Goodman, Shaun G.

AU - Granger, Christopher B.

AU - Grieve, Richard

AU - Nicolau, Jose C.

AU - Simon, Tabassome

AU - Westermann, Dirk

AU - Yasuda, Satoshi

AU - Hedman, Katarina

AU - Rennie, Kirsten L.

AU - Sundell, Karolina Andersson

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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