Performance of PREVENT equations for cardiovascular risk prediction in young patients with myocardial infarction: From the MGB YOUNG-MI registry

Background

Predicting cardiovascular risk in young adults remains challenging. The newly developed PREVENT equations offers several advantages for short and long-term cardiovascular risk prediction.

Objective

To determine how often PREVENT equations identify increased cardiovascular risk among young adults who experience premature myocardial infarction compared with existing risk calculators

Methods

The YOUNG-MI registry is a retrospective cohort from two large academic centers, which included individuals who experienced an MI at age ≤ 50 years. Study physicians adjudicated diagnosis of Type 1 MI. Cardiovascular risk was estimated by pooled cohort equations and PREVENT equations based on data available prior to MI or at the time of presentation.

Results

The study cohort included 1149 individuals with a median age of 45 years and 19 % women. The median 10-year ASCVD risk calculated by pooled cohort equations and 2023 PREVENT equations was 4.6 % and 2.3 %, respectively. Using the 10-year ASCVD risk estimates from the 2023 PREVENT equations, only 33 (3 %) individuals met the 7.5 % threshold while 93 (8 %) met the 5 % threshold and 333 (29 %) met the 3 % threshold. For 30-year ASCVD risk using PREVENT, 827 (72 %) met a threshold of ≥ 10 %.

Conclusion

The PREVENT equations may lead to undertreatment of young adults who experienced an MI. Using the 30-year risk PREVENT equations may improve long-term risk assessment in this population.