Key result
A novel risk prediction score incorporating age, history of hypertension, atrial fibrillation, and target lesion involving branches accurately predicted 5-year stroke risk after primary PCI with a validation AUC of 0.846.
Why the study?
Stroke carries high mortality and impairs quality of life after primary PCI, motivating the development and validation of a novel marker-based risk score to improve stroke prognostication in patients with MI.
Does a novel marker-based risk score accurately predict the incidence of long-term cerebrovascular events in patients with MI undergoing primary PCI?
Cohort (n=4,103)
No
Does a novel marker-based risk score accurately predict the incidence of long-term cerebrovascular events in patients with MI undergoing primary PCI?
Effect estimate: AUC 0.846 (95% CI 0.821-0.869)
p-value: p=<0.001
A newly developed risk score demonstrates good discrimination for predicting 5-year stroke risk in patients with MI undergoing primary PCI.
INTRODUCTION: Although the rates of long‑term outcome events are low, stroke is associated with high short- and long‑term mortality and adversely affects the quality of life of patients with a history of primary percutaneous coronary intervention (PCI). OBJECTIVES: We sought to develop and validate a novel marker‑based risk score to improve stroke prognostication in patients with myocardial infarction (MI) undergoing primary PCI. PATIENTS AND METHODS: A retrospective study was conducted to internally validate a new biomarker‑based risk score for the incidence of stroke in 4103 patients with MI undergoing primary PCI who were randomized into derivation and validation cohorts. RESULTS: Significant predictors of cerebrovascular events included age, history of atrial fibrillation, history of hypertension, and the target lesion involving branches. The models had good calibration and discrimination in both derivation and internal validation. The areas under the receiver operating characteristic curve for predicting cerebrovascular events were 0.826 (sensitivity, 84.78%; specificity, 65.18%) and 0.846 (sensitivity, 71.43%; specificity, 90.29%) for the derivation and validation cohorts, respectively, at the 5‑year follow‑up. We calculated the total risk score for each participant, and divided them into low- and high‑risk groups according to the median of the total risk score. A Kaplan-Meier survival analysis for the cohort showed significant differences in the total cohort (P <0.001) and derivation cohorts (P = 0.001). CONCLUSIONS: The prediction model was internally validated and calibrated in large cohorts of patients with MI receiving primary PCI therapy. This risk score allows re‑evaluation of the risk of cerebrovascular events in patients after primary PCI.
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Zhao et al. (2021) conducted a cohort in Acute myocardial infarction (n=4,103). High risk score (incorporating age, hypertension, atrial fibrillation, and target lesion involving branches) vs. Low risk score was evaluated on 5-year incidence of cerebrovascular events (stroke) (AUC 0.846, 95% CI 0.821-0.869, p=<0.001). A novel risk prediction score incorporating age, history of hypertension, atrial fibrillation, and target lesion involving branches accurately predicted 5-year stroke risk after primary PCI with a validation AUC of 0.846.
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