Vall d'Hebron Risk Score II for myocardial infarction and cardiac death

Area of Science:

• Cardiology
• Nuclear Cardiology
• Medical Imaging

Background:

• Accurate risk stratification for cardiac events is crucial in cardiovascular medicine.
• Existing risk scores may not fully capture risk in patients with or without prior myocardial infarction (MI) or coronary revascularisation (CR).
• Gated single-photon emission CT (SPECT) provides valuable functional and anatomical information for risk assessment.

Purpose of the Study:

• To develop and validate a novel risk score, the Vall d'Hebron Risk Score-II (VH-RS-II).
• To predict the risk of non-fatal myocardial infarction (MI) and/or cardiac death (CD) in patients undergoing gated SPECT.
• To exclude patients who undergo coronary revascularisation (CR) during follow-up from the analysis.

Main Methods:

• Analysis of 5215 consecutive patients undergoing gated SPECT.
• Stratification into two groups: no previous MI and/or CR (2960 patients) and previous MI and/or CR (2255 patients).
• Multivariate Cox and logistic regression analyses to identify independent predictors of cardiac events (CE), followed by validation in 679 patients.

Main Results:

• In patients without prior MI/CR, predictors of CE included age, diabetes, metabolic equivalent (METs), ST segment depression, ejection fraction (EF), and summed stress score (C-statistic: 0.8).
• In patients with prior MI/CR, predictors of CE included age, male sex, smoking status, METs, ST segment depression, EF, and summed difference score (C-statistic: 0.8).
• The VH-RS-II demonstrated good predictive accuracy in both patient cohorts.

Conclusions:

• The VH-RS-II, derived from clinical exercise and gated SPECT variables, enables effective risk stratification for MI and CD.
• The score is applicable to patients with or without a history of MI or CR.
• VH-RS-II provides a valuable tool for personalized risk assessment in cardiology.