Abstract MP009: Contemporary Risk Stratification After Myocardial Infarction in the Community: Performance of Scores and Incremental Value of ST2
Background: Current AHA/ACC guidelines recommend the GRACE and TIMI scores for assessing myocardial infarction (MI) prognosis. With recent major changes in the epidemiology of MI and new biomarkers available for risk stratification, an updated assessment of the performance of these scores is needed in a real-world practice setting.
Objectives: We assessed (a) the performance of GRACE and TIMI in predicting 1-year mortality among a community cohort of MI patients stratified by ST- and non-ST-segment elevation MI (STEMI/NSTEMI) and (b) the incremental discriminatory power of soluble ST2, a myocardial fibrosis biomarker.
Methods: Olmsted County, Minnesota residents with incident MI (N=1,401) were recruited prospectively from 2002-2012 (mean age, 67 years; 61% men; 79% NSTEMI). Baseline data were used for calculating risk scores; stored plasma samples obtained shortly after MI were used for ST2 measurement. C-statistics adapted to survival data were used to assess the discriminatory power of GRACE and TIMI and the improvement gained by incorporating additional variables.
Results: During the first year of follow-up, 190 (14%) patients died. The overall discriminatory performance in predicting death was reasonable for GRACE and poor for TIMI, and was generally worse in NSTEMI vs STEMI. In NSTEMI, sequential addition of comorbidities and ST2 substantially improved the c-statistic over GRACE (from 0.78 to 0.80 to 0.84) and TIMI (from 0.61 to 0.73 to 0.81), respectively (all P ≤ 0.05).
Conclusions: Guidelines-recommended scores for risk assessment post-MI underperform in contemporary community patients with NSTEMI, which now represent the majority of infarcts. Incorporating comorbidities and ST2 substantially improves risk prediction thereby delineating opportunity to improve clinical care.
Author Disclosures: Y. Gerber: None. S. Weston: None. M. Enriquez-Sarano: None. A. Jaffe: None. S. Manemann: None. R. Jiang: None. V.L. Roger: None.
- © 2017 by American Heart Association, Inc.