In patients with heart failure after acute myocardial infarction, incorporating NLR into the AHEAD score (AHEAD-NLR) significantly improved long-term all-cause mortality risk prediction with a 26.1% net reclassification improvement over the original AHEAD score.
Observational (n=840)
No
Does the AHEAD-NLR score improve the prediction of long-term all-cause mortality compared to the AHEAD score in patients with heart failure after acute myocardial infarction?
Integrating the neutrophil-to-lymphocyte ratio (NLR) into the AHEAD score significantly improves long-term mortality risk stratification for patients who develop heart failure following an acute myocardial infarction.
Effect estimate: HR 1.356 for AHEAD score per point after adjustment; AHEAD score HR 2.210 univariate; AHEAD-NLR score improved predictive performance with net reclassification improvement (NRI) 0.261 (26.1%) and integrated discrimination improvement (IDI) 0.042 (95% CI Adjusted HR for AHEAD score 1.270 (1.019–1.582); Univariate HR for AHEAD 2.210 (1.83–2.67); NRI 95% CI (0.108–0.413); IDI 95% CI (0.009–0.074))
p-value: p=Adjusted p=0.001 for AHEAD score; p=0.007 for NRI and IDI improvements
The AHEAD score (Atrial fibrillation, Hemoglobin, Elderly age, Abnormal renal function, and Diabetes) has proven valuable for risk stratification in acute heart failure. However, its prognostic utility specifically in the distinct and high-risk population of patients who develop heart failure after an acute myocardial infarction (AMI) remains to be clarified. Current risk assessment tools in this setting often underrepresent the significant role of systemic inflammation, a key driver of adverse remodeling and poor outcomes post-AMI. To address this gap, we incorporated the Neutrophil-to-lymphocyte ratio (NLR), a robust and readily available marker of inflammatory response. The modified AHEAD-NLR score aims to integrate established clinical risk factors with inflammatory activity, thereby addressing a critical limitation of prior tools and potentially offering a more comprehensive prognostic model. A total of 840 patients with heart failure after AMI were enrolled in this study (age 62.55 ± 11.89 years, 81.90% men), with a median follow-up duration of 954 days. The predictive efficacy of the AHEAD score for all-cause mortality was evaluated using Cox regression analysis. The mean AHEAD score of study was 1.05 ± 1.04. After adjusting for age, gender, red cell distribution width (RDW), uric acid, serum potassium, D-dimer, Neutrophil-to-lymphocyte ratio (NLR), and Left ventricular ejection fraction(LVEF), the AHEAD score was still significantly associated with an increased risk of all-cause mortality (hazard ratio and 95% confidence interval: 1.270, 1.019-1.582). In addition, when we constructed a new score, AHEAD-NLR, by incorporating the NLR (≥ 8.16) into the AHEAD score, the net reclassification improvement for predicting all-cause mortality was increased by 19.9%. AHEAD score is an independent predictor of all-cause mortality in patients with HF after AMI. AHEAD-NLR score, which integrates clinical risk factors and inflammatory status, further optimizes risk stratification, offering a more comprehensive prognostic tool for this high-risk population.
Lin et al. (Fri,) conducted a observational in Patients with heart failure after acute myocardial infarction (mean age 62.55 ± 11.89 years, 81.90% male) (n=840). AHEAD-NLR score integrating Neutrophil-to-Lymphocyte Ratio (NLR) with AHEAD score vs. AHEAD score alone was evaluated on All-cause mortality over a median follow-up of 954 days (HR 1.356 for AHEAD score per point after adjustment; AHEAD score HR 2.210 univariate; AHEAD-NLR score improved predictive performance with net reclassification improvement (NRI) 0.261 (26.1%) and integrated discrimination improvement (IDI) 0.042, 95% CI Adjusted HR for AHEAD score 1.270 (1.019–1.582); Univariate HR for AHEAD 2.210 (1.83–2.67); NRI 95% CI (0.108–0.413); IDI 95% CI (0.009–0.074), p=Adjusted p=0.001 for AHEAD score; p=0.007 for NRI and IDI improvements). In patients with heart failure after acute myocardial infarction, incorporating NLR into the AHEAD score (AHEAD-NLR) significantly improved long-term all-cause mortality risk prediction with a 26.1% net reclassification improvement over the original AHEAD score.