Key result
Higher S2I2N0-3 score linked to ~18% greater long-term CV death risk per point, matching MAGGIC.
Why the study?
This study investigated whether the S2I2N0–3 score could forecast mortality and morbidity in patients with HFrEF.
Does the S2I2N0-3 score predict short- and long-term mortality and morbidity in patients with HFrEF?
Cohort (n=890)
Does the S2I2N0-3 score predict short- and long-term mortality and morbidity in patients with HFrEF?
The S2I2N0-3 score offers a simple and reliable prognostic tool for predicting short- and long-term outcomes in HFrEF patients, performing comparably to the established MAGGIC score.
May aid HFrEF risk stratification; leaves open superiority to MAGGIC pending prospective validation.
Aims This study investigated the S2I2N0–3 score, a simple tool comprising stroke history, insulin-treated diabetes, and N-terminal pro-brain natriuretic peptide, for forecasting mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). Methods and results Analysing 890 GUIDE-IT HFrEF trial participants, we stratified them by baseline S2I2N0–3 risk score into three risk groups. We examined the score's association with five adverse outcomes over short (90 days) and extended periods (median follow-up of 15 months) using Cox and competing risk models. Our analysis revealed significant positive associations between the S2I2N0–3 strata and adverse outcomes. When analysed as a continuous variable, each point increment of the S2I2N0–3 score was associated with a higher risk of short- and long-term cardiovascular death [short term: hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.03–1.98; long term: HR 1.18, 95% CI 1.02–1.38], all-cause death (HR 1.52, 95% CI 1.12–2.07; HR 1.18, 95% CI 1.03–1.36), HF hospitalization (HR 1.39, 95% CI 1.20–1.62; HR 1.18, 95% CI 1.06–1.31), any hospitalization (HR 1.19, 95% CI 1.06–1.34; HR 1.09, 95% CI 1.00–1.19), and the composite outcome of cardiovascular death and HF hospitalization (HR 1.39, 95% CI 1.21–1.60; HR 1.17, 95% CI 1.06–1.30). The S2I2N0–3 demonstrated reliable prognostic value, with C-indices ranging from 0.619 to 0.753 across outcomes and time points. When compared with the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score using Z-statistics, net reclassification index, and integrated discrimination improvement, the S2I2N0–3 showed comparable predictive power for all outcomes during both short- and long-term follow-ups. Conclusions The S2I2N0–3 risk score had modest predictive values for both short- and long-term clinical outcomes in HFrEF patients, offering equivalent performance to the established MAGGIC score.
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Sun et al. (2024) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=890). S2I2N0–3 score vs. Per point increment was evaluated on Long-term cardiovascular death (HR 1.18, 95% CI 1.02-1.38). Each point increment in the S2I2N0–3 score was associated with a higher risk of long-term cardiovascular death (HR 1.18; 95% CI 1.02–1.38) and showed comparable predictive power to the MAGGIC score.
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