Universal Risk Prediction for Individuals With and Without Atherosclerotic Cardiovascular Disease

Dynamic and Static Effects of the Systemic Inflammatory Response Index on All-Cause Mortality in Individuals With Atherosclerotic Cardiovascular Disease: Evidence From National Health and Nutrition Examination Survey

Objective: This research focuses on analyzing the link between the systemic inflammatory response index (SIRI) and all-cause mortality in individuals with atherosclerotic cardiovascular disease (ASCVD) . Methods: This research analyzed data from 4693 patients using nine cycles of the National Health and Nutrition Examination Survey (NHANES). The connection between SIRI and mortality was determined by employing survey-weighted Cox models, with hazard ratios (HRs) and 95% confidence intervals (CIs) being computed. Kaplan-Meier method illustrated survival differences across SIRI levels. Sensitivity analyses involved restricted cubic splines (RCS), stratified analysis, and E-value calculations. Landmark analysis assessed survival differences at multiple follow-up intervals, while time-dependent receiver operating characteristic curves evaluated SIRI's prognostic value. Mediation analysis identified potential intermediaries impacting the SIRI-mortality relationship. Results: Over 406,564 person-months, 1933 deaths occurred. Adjusted Cox models discovered that higher SIRI was connected with elevated overall mortality [HR 1.192, (95% CI 1.131-1.256), p < 0.001]. Higher SIRI consistently showed lower survival probabilities. RCS and stratified analysis confirmed the robustness of these findings. Survival probability at different follow-up periods was considerably lower in those with higher SIRI. Additionally, SIRI demonstrated a prognostic value of 0.66 for all-cause mortality at 1 year and 3 years, and 0.65 at 5 years. Notably, serum uric acid (6.2%) partially mediated the connection between SIRI and mortality from all causes. Conclusion: In ASCVD patients, SIRI was robustly correlated with all-cause mortality, partially mediated by serum uric acid.

Prediction of Recurrent Venous Thromboembolism and Arterial Cardiovascular Events after Discontinuation of Anticoagulation: The R-VTE-predict and MACE-predict Risk Scores

Patients who had venous thromboembolism (VTE) are not only at increased risk of recurrent VTE but also of major adverse cardiovascular events (MACEs) than the general population. Therefore, the prediction of the risk of these events is important for a tailored prevention and mitigation strategy. We aimed to develop simple scores to estimate recurrent VTE and MACE risks after the discontinuation of anticoagulation in a large cohort of individuals who suffered VTE (EDITH cohort). The primary endpoints were recurrent symptomatic VTE and MACE (composite of non-fatal acute coronary syndrome, stroke and cardiovascular death). Arterial thrombotic event (ATE) exclusively was also considered. Independent predictors of main outcomes were derived from multivariable Cox regression models. Weighted integer points based on the effect estimate of identified predictors were used to derive the final risk scores. A total of 1,999 participants (mean age: 54.78 years, 46.4% male, 43.6% unprovoked VTE) were included in the derivation cohort and 10,000 in the validation cohort (built using bootstrapping). During a median post-anticoagulation follow-up of 6.9 years, recurrent VTE occurred in 29.5% of participants and MACE in 14.8%. Independent predictors of recurrent VTE were male sex, age >65 years, cancer-associated VTE, and unprovoked VTE (vs. transient risk factor-associated VTE). Independent predictors of MACE were age >65 years, cancer-associated VTE, hypertension, renal insufficiency, and atrial fibrillation. The risk of recurrent VTE (moderate vs. low: hazard ratio [HR]: 2.62, 95% confidence interval [CI]: 2.06-3.34; high vs. low: HR: 3.78, 95% CI: 2.91-4.89), MACE (moderate vs. low: HR: 6.37, 95% CI: 3.19-12.69; high vs. low: HR: 12.32, 95% CI: 6.09-24.89), and ATE (based on MACE-predict risk score) increased gradually from the lowest to highest of the respective prediction risk score groups. These results were confirmed in the validation cohort with overall reasonable models' discrimination performance (recurrent VTE C-statistic: 0.62-0.63, MACE and ATE C-statistic: 0.72-0.77). Contemporary simple risk scores based on readily available clinical characteristics can reasonably predict the risk of recurrent VTE and MACE after the discontinuation of anticoagulation. These findings may influence the choice of anticoagulation strategy after the acute phase of VTE and, therefore, need confirmation by further studies.

Prediction of major adverse cardiovascular events following acute myocardial infarction using electrocardiogram DETERMINE score

BACKGROUND

Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity globally, with a high incidence of major adverse cardiovascular events (MACE) post-primary percutaneous coronary intervention (PPCI). The DETERMINE score, derived from electrocardiographic (ECG) markers, has shown promise as a predictor of adverse outcomes, but its clinical utility requires further validation.

OBJECTIVE

To evaluate the predictive value of the DETERMINE score for MACE and provide early clinical warnings for high-risk patients.

METHODS

This bidirectional cohort study included AMI patients from the Second Affiliated Hospital of Anhui Medical University between 2019 and 2023. The training cohort comprised 545 patients between January 2019 and January 2023, while the validation cohort consisted of 122 patients between February 2023 and July 2023. The primary endpoint was MACE within one-year post-PPCI. The relationship between the DETERMINE score and MACE was analyzed using Cox regression, trend tests, and restricted cubic splines to assess linear and nonlinear associations. Patients were stratified into risk groups based on tertiles or optimal cutoffs, and Kaplan-Meier survival curves compared MACE incidence across groups. Predictive accuracy was evaluated through time-dependent C-index, ROC curves, decision curve analysis, and calibration, and compared to other prognostic scores, including the Selvester, GRACE, and SYNTAX scores, as well as left ventricular ejection fraction (LVEF). Subgroup analyses by sex, age, and culprit artery involvement were also conducted.

RESULTS

Cox multivariate regression indicated that the DETERMINE score was an independent risk factor for MACE (HR = 1.56, 95% CI 1.38-1.75, P < 0.001). Trend test and RCS showed a positive correlation and non-linear relationship between the DETERMINE score and MACE (P-trend < 0.001, P-overall < 0.001, P-nonlinear: 0.003). Kaplan-Meier survival analysis revealed that, in both the training and validation datasets, groups with a higher DETERMINE score showed a higher cumulative risk of MACE. The DETERMINE score outperformed traditional prognostic scores (Selvester, GRACE, SYNTAX) in terms of predictive accuracy, with an AUROC of 0.840 at 12 months in the training cohort. The score also provided a substantial clinical net benefit, particularly over longer follow-up periods. Subgroup analyses confirmed its predictive power across different demographics and clinical presentations.

CONCLUSION

The DETERMINE score has outstanding predictive power for MACE post-PPCI, which can guide the early identification of high-risk patients with poor prognosis of AMI in clinical practice.

When Does Primary Prevention Encroach on Secondary Prevention?

PURPOSE OF REVIEW

The risk of incident atherosclerotic cardiovascular disease (ASCVD) in primary prevention is typically lower than in secondary prevention. However, there is a spectrum of risk among individuals undergoing primary prevention with the risk in some individuals approaching those of secondary prevention. We review the clinical conditions wherein the risk in primary prevention is similar to that observed in secondary prevention.

RECENT FINDINGS

Among individuals without established ASCVD, coronary artery calcium (CAC) scores ≥ 300 AU are associated with ASCVD event rates similar to secondary prevention populations. CAC score ≥ 1,000 AU are associated with an ASCVD risk seen in very high-risk secondary prevention populations. Interpretation of these observations must however consider differences in the risk reduction strategies. Current guidelines dichotomize ASCVD prevention into primary and secondary prevention, but certain primary prevention patients have an ASCVD risk equivalent to that of secondary prevention populations. Identifying higher risk primary prevention populations will allow for better risk mitigation strategies.