Pre-discharge prediction of long-term prognosis in patients after ST-segment elevation myocardial infarction - the ValAMI-P risk score

Abstract Background Despite contemporary management of ST-segment elevation myocardial infarction (STEMI) patients, cardiovascular death (CV death) and re-admission for acute heart failure (aHF) are frequent complications during follow-up. Several clinical, electrocardiographic, and echocardiographic variables have been identified as risk factors of major adverse cardiovascular events (MACE) in this setting. We aim to study the usefulness of a risk score using universally available clinical, electrocardiographic, and echocardiographic variables at discharge to stratify the risk of MACE during follow-up. Methods We prospectively included 712 patients treated with primary percutaneous coronary intervention after STEMI. We registered clinical, ECG and echocardiography-derived pre-discharge data. Left ventricular ejection fraction (LVEF) was categorized according to current recommendations. The primary endpoint was time to first MACE, defined as CV death or aHF, whichever occurred first. We created a risk score (ValAMI-P) including variables independently associated with MACE in multivariable analysis. Patients were classified in three groups (low, intermediate, and high risk) according to the ValAMI-P score. Results Mean age was 60±12 years, most patients (78.5%) were male, and smoking was the most prevalent risk factor (54.4%). During an 8.1-year median follow-up, 154 MACE (21.6%) were registered. In multivariable analysis, age (HR 1.03 [1.01-1.05], p=0.001), previous hypertension (HR 1.49 [1.04-2.12], p=0.029), GRACE score (HR 1.01 [1.01-1.02], p<0.001), mildly reduced LVEF (41-49%; HR 1.92 [1.18-3.11], p=0.008), reduced LVEF (≤40%; HR 5.2 [3.53-7.65], p<0.001) and the number of leads with Q-wave and residual ST-segment elevation at pre-discharge ECG (Q-STE; HR 1.13 [1.03-1.25], p=0.013) associated with long-term MACE. After classification according to the ValAMI-P risk score, patients with intermediate (8-13 points) and high (≥14 points) score depicted an increased risk of MACE (31% and 50%, respectively) compared to patients with low ValAMI-P risk score (≤7 points; 13%; p<0.001 for all comparisons). Conclusions The ValAMI-P risk score, which comprises widely available clinical, ECG and echocardiographic variables at discharge, can identify patients at increased long-term risk of MACE after STEMI.ValAMI-P risk score after STEMI