Circulating multiple metals and mortality after myocardial infarction: incremental value beyond GRACE

Area of Science:

• Cardiovascular Medicine
• Environmental Health
• Toxicology

Background:

• Emerging evidence links heavy metals (e.g., arsenic, cadmium, lead) to cardiovascular disease.
• Current clinical risk stratification for myocardial infarction (MI) patients does not account for metal exposure.
• This gap highlights the need to investigate the prognostic impact of metals in post-MI populations.

Purpose of the Study:

• To investigate the association between plasma metal concentrations and all-cause mortality in patients post-MI.
• To develop and validate an environmental metal risk score (ERS) for improved risk prediction.
• To assess the incremental prognostic value of ERS when added to the established GRACE risk score.

Main Methods:

• Prospective cohort study of 1,283 post-MI patients undergoing percutaneous coronary intervention (PCI).
• Plasma levels of 19 metals measured using inductively coupled plasma mass spectrometry.
• Multivariable Cox models and elastic net regularized Cox models used to assess associations and derive ERS.

Main Results:

• 122 all-cause mortality events occurred during a median follow-up of 4.28 years.
• Higher plasma copper, lead, and strontium levels were significantly associated with increased all-cause mortality.
• The environmental metal risk score (ERS) improved risk discrimination and reclassification when added to the GRACE score.

Conclusions:

• Plasma copper, lead, and strontium are associated with mortality risk in post-MI patients.
• The developed ERS demonstrates potential for enhancing cardiovascular risk prediction.
• Further validation in independent cohorts is recommended prior to clinical application.