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Time-Varying Prognostic Impact of the Age×BUN/LVEF Index on Long-Term MACCE After ST-Elevation Myocardial Infarction
Seda Elcim Yildirim1, Tarik Yildirim1, Mehmet Tolga Hekim1
1Department of Cardiology, School of Medicine, Balikesir University, 10145 Balikesir, Turkey.
Insights
A new index combining age, blood urea nitrogen, and ejection fraction (AGEBUNeFR) effectively predicts long-term adverse events after ST-elevation myocardial infarction (STEMI) treated with primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Long-term adverse events remain frequent after ST-elevation myocardial infarction (STEMI) despite reperfusion therapies.
- There is a need for practical risk stratification tools at presentation for STEMI patients.
- Existing models may not fully capture long-term risks associated with primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the prognostic value of a novel composite index, Age×BUN/LVEF (AGEBUNeFR), for predicting long-term major adverse cardiac and cerebrovascular events (MACCE) in STEMI patients.
- To assess the index's performance in patients undergoing primary PCI.
- To determine if the index provides incremental prognostic information beyond conventional methods.
Main Methods:
- Retrospective analysis of 313 STEMI patients treated with primary PCI (2020-2024).
- Calculation of the AGEBUNeFR index using age, admission blood urea nitrogen, and left ventricular ejection fraction.
- Long-term follow-up for MACCE (all-cause mortality, recurrent MI, repeat revascularization, stroke, heart failure hospitalization) with a median of 2.24 years.
Main Results:
- 93 patients (29.7%) experienced MACCE during follow-up.
- The AGEBUNeFR index was independently associated with MACCE (adjusted HR 1.028 per unit increase, p < 0.001).
- Time-varying analysis showed significant early and late prognostic effects, particularly after 36 months (p < 0.001).
Conclusions:
- The AGEBUNeFR index is a simple, accessible, and potent predictor of long-term MACCE in STEMI patients post-primary PCI.
- This index integrates age, renal/hemodynamic stress, and cardiac function for dynamic risk assessment.
- AGEBUNeFR offers incremental prognostic value, supporting its use as a practical tool for long-term risk stratification.
Background:
Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, blood urea nitrogen, and left ventricular ejection fraction (Age×BUN/LVEF) for predicting long-term MACCE in STEMI patients treated with primary percutaneous coronary intervention (PCI).
Methods:
This retrospective, single-center cohort study included 313 consecutive STEMI patients undergoing primary PCI between 2020 and 2024. The Age×BUN/LVEF (AGEBUNeFR) index was calculated using age and admission blood urea nitrogen values and left ventricular ejection fraction assessed during index hospitalization. The primary outcome was long-term MACCE, defined as a composite of all-cause mortality, recurrent myocardial infarction, repeat revascularization, stroke, and heart failure hospitalization. The median follow-up was 2.24 years (interquartile range 1.40-3.06).
Results:
During follow-up, 93 patients (29.7%) experienced MACCE. The AGEBUNeFR index was independently associated with MACCE after multivariable adjustment (adjusted HR 1.028 per unit increase, 95% CI 1.016-1.040; p < 0.001). Time-varying analyses demonstrated a dynamic prognostic effect, with significant associations in the early post-PCI period (p = 0.002) and a pronounced re-emergence of risk during late follow-up (>36 months; p < 0.001).
Conclusions:
The AGEBUNeFR index is a simple, readily available, and powerful predictor of long-term MACCE in STEMI patients undergoing primary PCI. By integrating age, renal/hemodynamic stress, and cardiac function, this composite index provides dynamic and incremental prognostic information beyond conventional clinical models, supporting its potential role as a practical tool for long-term risk stratification after STEMI.
