The AHEAD score as a predictor of all-cause mortality in patients with acute myocardial infarction: a secondary analysis of the Japan Acute Myocardial Infarction Registry

Background: The AHEAD score - comprising atrial fibrillation, haemoglobin, elderly age, abnormal renal function, and diabetes mellitus - is a validated prognostic model for patients with heart failure. However, its predictive value in acute myocardial infarction (MI), particularly in large real-world cohorts, remains uncertain. Aims: We aimed to assess the utility of the AHEAD score in predicting 1-year all-cause mortality in patients with acute MI. Methods: This secondary analysis of the Japan Acute Myocardial Infarction Registry (JAMIR) included 3,067 patients with acute MI enrolled across 50 Japanese institutions between December 2015 and May 2017. Patients were stratified by AHEAD score at admission. The primary endpoint was all-cause mortality within 1 year after acute MI. Multivariable Cox regression, Kaplan-Meier survival analysis, and restricted cubic spline modelling were used to evaluate the association between the AHEAD score and mortality. Results: Higher AHEAD scores were associated with older age, more comorbidities, a higher Killip class, and delayed reperfusion. The 1-year all-cause mortality rate increased significantly with rising AHEAD scores. The AHEAD score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.60; 95% confidence interval: 1.39-1.84; p<0.001), and this association was consistent across predefined subgroups. Spline analysis demonstrated a linear relationship between the AHEAD score and the mortality risk. Conclusions: The AHEAD score is a simple, bedside-accessible tool that effectively predicts 1-year all-cause mortality in patients with acute MI, regardless of the presence of heart failure. Its use may aid early risk stratification and guide clinical decision-making in acute cardiovascular care. This study was registered with the Japanese UMIN Clinical Trials Registry (UMIN000019479).