Thrombogenicity and central pulse pressure to enhance prediction of ischemic event occurrence in patients with established coronary artery disease: The MAGMA-ischemia score

Kevin P. Bliden, Rahul Chaudhary, Eliano P. Navarese, Tushar Sharma, Himabindu Kaza, Udaya S. Tantry, Paul A. Gurbel

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims Conventional cardiovascular risk estimators based on clinical demographics have limited prediction of coronary events. Markers for thrombogenicity and vascular function have not been explored in risk estimation of high-risk patients with coronary artery disease. We aimed to develop a clinical and biomarker score to predict 3-year adverse cardiovascular events. Methods Four hundred eleven patients, with ejection fraction ≥40% undergoing coronary angiography, and found to have a luminal diameter stenosis ≥50%, were included in the analysis. Thrombelastography indices and central pulse pressure (CPP) were determined at the time of catheterization. Results We identified predictors of death, myocardial infarction (MI) or stroke and developed a numerical ischemia risk score. The primary endpoint of cardiovascular death, MI or stroke occurred in 22 patients (5.4%). The factors associated with events were age, prior PCI or CABG, diabetes, CPP, and thrombin-induced platelet-fibrin clot strength, and were included in the MAGMA-ischemia score. The MAGMA-ischemia score showed a c-statistic of 0.85 (95% Confidence Interval [CI] 0.80–0.87; p<0.001) for the primary endpoint. In the subset of patients who underwent revascularization, the c-statistic was 0.90 (p<0.001). Patients with MAGMA-ischemia score greater than 5 had highest risk to develop clinical events, hazard ratio for the primary endpoint: 13.9 (95% CI 5.8–33.1, p<0.001) and for the secondary endpoint: 4.8 (95% CI 2.3–9.6, p<0.001). When compared to previous models, the MAGMA-ischemia score yielded a higher discrimination. Conclusions Inclusion of CPP and assessment of thrombogenicity in a novel score for patients with documented CAD enhanced the prediction of events.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalAtherosclerosis
Volume268
DOIs
StatePublished - Jan 2018

Keywords

  • Adverse cardiovascular outcomes
  • CAD
  • Central pulse pressure
  • Risk assessment
  • Thrombogenicity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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