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

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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 1,158 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.

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