Key result
Longitudinal psychosocial, sleep, and clinical measures modestly improve MACE prediction over GRACE alone.
Why the study?
The risk of MI evolves beyond the acute phase, and in-hospital tools like the GRACE score may not fully capture long-term vulnerability.
Does the addition of longitudinal psychosocial, sleep, and clinical assessments improve the prediction of MACE compared to the GRACE score alone in patients with first MI?
Cohort (n=319)
No
Does the addition of longitudinal psychosocial, sleep, and clinical assessments improve the prediction of MACE compared to the GRACE score alone in patients with first MI?
Effect estimate: C-index 0.684
Incorporating longitudinal psychosocial and sleep assessments provides modest incremental prognostic value for predicting long-term MACE after a first MI compared to the GRACE score alone.
Objectives: The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability. We evaluated whether simple longitudinal clinical and patient-reported measures improved the prediction of major adverse cardiovascular events (MACE). Subjects and Methods: In this prospective cohort study, 351 patients with first MI were enrolled at a rural tertiary center in South India, of whom 319 formed the analytic cohort. MACE was defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization, as ascertained through hospital records and structured follow-up. Baseline clinical, biochemical, echocardiographic, and interviewer-administered psychosocial (PHQ-9 and GAD-7) and sleep variables were collected during hospitalization and follow-up (1, 6, and 12 months). Cox models were developed in stages, with the GRACE score as a baseline anchor and follow-up variables incorporated using the last available observations. Model performance was assessed using Harrell’s concordance index (C-index), time-dependent area under the curve (AUC), and bootstrap validation methods. Results: Over a median follow-up of 5.8 years, 94 patients (29.5%) experienced MACE. The baseline model modestly improved discrimination over GRACE alone (C-index, 0.622 vs. 0.556). The extended model showed higher discrimination (apparent C-index 0.684; optimism-corrected 0.660). Follow-up sleep quality, psychosocial symptoms, glycemic measures, and global longitudinal strain contributed to the model, although the estimates were imprecise. Conclusion: Longitudinal follow-up measures provided modest incremental prognostic information beyond a GRACE-based benchmark. Findings are exploratory and require external validation before clinical application.
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Mukkirla et al. (2026) conducted a cohort in first myocardial infarction (n=319). Longitudinal clinical, psychosocial, and sleep measures vs. GRACE score alone was evaluated on Major adverse cardiovascular events (cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization) (C-index 0.684). Longitudinal psychosocial, sleep, and clinical measures modestly improved the prediction of major adverse cardiovascular events over the GRACE score alone (C-index 0.684 vs 0.556).
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