Low previous cardiovascular risk of patients with ST-elevation myocardial infarction

Area of Science:

• Cardiology
• Preventive Medicine
• Public Health

Background:

• Coronary artery disease (CAD) often presents initially as myocardial infarction.
• Systemic Coronary Risk Estimation (SCORE) risk tables are standard for primary cardiovascular (CV) risk assessment.
• Accurate CV risk stratification is crucial for effective primary prevention strategies.

Purpose of the Study:

• To evaluate the performance of the SCORE risk charts in estimating CV risk for patients presenting with ST-elevation myocardial infarction (STEMI) as their first manifestation of CAD.
• To assess the accuracy of pre-event SCORE calculations in identifying individuals at high risk for future cardiovascular events.

Main Methods:

• Analysis of a prospective registry of 3056 patients with STEMI undergoing coronary angiography (2004-2014).
• Inclusion of 1628 patients with STEMI as their first CAD manifestation, excluding those with prior CAD, high-risk equivalents, or normal coronaries.
• Calculation of individual SCORE risk profiles using pre-event data for risk stratification into low, high, and very high-risk categories.

Main Results:

• Over two-thirds of patients (71.4%) with STEMI as their first CAD event were classified as low risk (SCORE < 5%) prior to the event.
• Only a small proportion (3.5%) were classified as very high risk (SCORE ≥ 10%).
• The majority of STEMI patients, when assessed pre-event using SCORE, fell into lower risk categories than their actual event indicated.

Conclusions:

• The SCORE risk charts significantly underestimate CV risk in patients experiencing STEMI as their first CAD manifestation.
• Current risk stratification tools may not adequately identify individuals who will experience a first STEMI event.
• There is a critical need for enhanced primary prevention strategies and additional tools to improve the identification of high-risk individuals for cardiovascular events.