The long-term prognostic value of the framingham risk scoring in patients with myocardial infarction with nonobstructive coronary arteries

Background

The Framingham Risk Score for Cardiovascular Disease (FRSCVD), based on the Framingham Heart Study, serves as a foundation for many prediction models. However, its applicability in predicting the long-term prognosis of patients experiencing myocardial infarction with nonobstructive coronary arteries (MINOCA) remains uncertain.

Methods

A cohort of 1158 MINOCA patients was enrolled and stratified into three groups based on 10-year FRSCVD risk. The primary endpoint was defined as major adverse cardiovascular events (MACE), which included all-cause mortality, non-fatal myocardial infarction, ischemic stroke, revascularization, and hospitalizations due to unstable angina or heart failure. Cox regression models, Kaplan-Meier survival curves, and receiver-operating characteristic (ROC) curve analyses were conducted.

Results

Over the median follow-up of 47.4 months, the incidence of MACE increased significantly in MINOCA patients with higher FRSCVD risk stratification (9.6 % vs. 12.5 % vs. 20.8 %; P < 0.001). Increased FRSCVD was independently associated with a higher risk of MACE after adjustment for relevant risk factors (HR 1.108, 95 % CI: 1.053–1.166, p < 0.001). The Kaplan-Meier curves also demonstrated a higher risk of MACE events in the high-risk FRSCVD group (log-rank P < 0.001). Time-dependent ROC analyses revealed that the area under the curve (AUC) of FRSCVD for predicting distant MACE in MINOCA patients was 0.687 (AUC at 1 year), 0.641 (AUC at 3 years), and 0.610 (AUC at 5 years).

Conclusions

FRSCVD demonstrates a significant association with long-term prognosis in MINOCA patients, exhibiting particular predictive value for heart failure progression while serving as a potential tool for early risk stratification.