Abstract 12443: Incident Heart Failure Risk After Acute Myocardial Infarction is Stratified by the Intermountain Major Adverse Cardiovascular Events (IMACE) Risk Scores
Introduction: Previously, the Intermountain Mortality Risk Scores (IMRS) were created to predict all-cause mortality, but also predicted incident heart failure (HF) in unselected catheterization laboratory patients. The Intermountain Major Adverse Cardiovascular Events (IMACE) risk scores were created using IMRS principles to predict MACE (CV mortality, recurrent myocardial infarction [MI], stroke) for acute MI patients.
Hypothesis: IMACE stratifies the risk of HF in acute MI patients free of HF at baseline.
Methods: Acute MI patients (females: 1,846; males: 4,720) hospitalized at the Intermountain Heart Institute (9/1993-4/2015) were included if they were free from a clinical HF diagnosis and (if available) had LVEF >40%. Incident HF was monitored electronically in Intermountain’s 22 hospitals. A composite of HF and all-cause mortality was also examined. IMACE was computed from previously-derived weightings for age, complete blood count and comprehensive metabolic panel factors, and B-type natriuretic peptide.
Results: Mean age at MI was 65.1±13.6 years in females and 59.8±12.3 in males. Cumulative HF-free survival was 90.2% during follow-up of 8.8±5.9 years (max: 21.6 years). Median time to HF diagnosis was 6.0 years, with a stable annual hazard (median 0.4%/year; interquartile range: 0.4%-0.6%). IMACE risk scores (high- vs. low-risk) predicted HF (Figure) in females (HR=3.72, CI=1.68, 8.27) and males (HR=6.90, CI=3.82, 12.48). IMACE predicted mortality/HF for females (HR=6.39, CI=4.83, 8.42) and males (HR=6.34, CI=5.12, 7.85). Other HF predictors were 16 of 53 clinical and treatment variables.
Conclusions: IMACE effectively stratified HF incidence after acute MI in patients initially free from HF. Data suggested high-risk females died prior to HF diagnosis. IMACE is a clinically feasible tool for efficiently identifying MI patients for whom additional evaluation and more aggressive therapeutic management may improve long-term prognosis.
Author Disclosures: B.D. Horne: Research Grant; Significant; This study funded by unrestricted grant from AstraZeneca. Other Research Support; Significant; Also has risk score-related grants from Intermountain Healthcare’s Foundry innovation program, the Intermountain Research and Medical Foundation, and Scriplogix, Inc.. Other; Significant; Inventor of risk scores that are licensed to Scriplogix, Inc. for commercial development. J.B. Muhlestein: Research Grant; Significant; This study funded by unrestricted grant from AstraZeneca. D. Bhandary: Employment; Significant; Employed by AstraZeneca. A.G. Kfoury: None. G.L. Hoetzer: Employment; Significant; Employed by AstraZeneca. T.L. Bair: None. N.D. Khan: Employment; Significant; Employed by AstraZeneca. D.L. Lappé: Research Grant; Significant; This study funded by unrestricted grant from AstraZeneca.
- © 2016 by American Heart Association, Inc.