Best Risk Score in Predicting Hard Cardiovascular Events in Patients with First Myocardial Infarction


  • Amit Chaudhary Department of Internal Medicine, TS Medical College, Lucknow, Author
  • Akanksha Verma Department of Anatomy, Dr. Ram Manohar Institute of Medical Sciences, Lucknow Author



CV Risk Assessment, RiskACC/AHA, Risk FRS, RiskWHO, RiskQRISK2


Background:Although a number of risk assessment models are available for estimating 10-year risk of cardiovascular (CV) events in patients requiring primary prevention of CV disease, the predictive accuracy of the contemporary risk models has not been adequately evaluated in Indians.

Methods: 412 patients [mean age 55.7±12.8 years; 320 (77.7%) males] without prior CV disease and presenting with acute myocardial infarction (MI) were included. The six clinically relevant risk assessment models [Framingham Risk score (RiskFRS-L), Framingham Risk score (RiskFRS-B), World Health Organization risk prediction charts (RiskWHO), American College of Cardiology/ American Heart Association pooled cohort equations (RiskACC/AHA) and the 3rd Joint British Societies' risk calculator (RiskJBS), Predicting cardiovascular risk in England and Wales(RiskQRISK2)]. Risk scores were applied to estimate what would have been their predicted 10-year risk of CV events if they had presented just prior to suffering the acute MI.

Results: RiskACC/AHA provided the lowest risk estimates with 74.4% patients estimated to be having <20% 10-year risk. RiskJBS provided intermediate risk (67.3% with risk, 20%).  In comparison, RiskFRS-L and RiskFRS-B, Risk returned higher risk estimates (53.6% and 50.1% with risk <20%, respectively; p values <0.001 for comparison with RiskWHO). However, RiskQRISK-2 identified the highest proportion of the patients as being at high-risk the (only 51% at <20% risk, p values 0 < 0.01 for comparison with RiskACC/AHA, RiskJBS risk scores).

Conclusion: This is the first study to show that in Indian patients presenting with acute MI, RiskQRISK-2 is likely to identify the largest proportion of the patients as at high-riskas compared to RiskWHO, RiskFRS-L, RiskFRS-B and RiskACC/AHA. However, large-scale prospective studies are needed to confirm these findings.


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