SPC365

Performance of the MAGGIC score in predicting all-cause death and cardiovascular events in coronary heart disease patients

Session: Posters (Sessão 4 - Écran 2) - Insuficiência cardíaca - estratificação de risco
Speaker: Bruno Bragança

Congress: CPC 2023
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Bruno Bragança; Rafaela G. Lopes; Inês G. Campos; Inês Oliveira; Isabel Cruz; Inês G. Campos; Joel P. Monteiro; Conceição Queirós; Paulo Pinto; Aurora Andrade

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Risk stratification in Chronic Heart failure (CHF) has provided valuable refinement in identifying patients who will benefit most from high levels of care and advanced therapies. The MAGGIC score has been demonstrated to be superior to other validated scores in predicting survival in symptomatic CHF (ACC/AHA stage C and D)<sup>1</sup>. However, its value in earlier stages of CHF remains unknown; thus, we aim at exploring the prognostic impact of MAGGIC score in patients with coronary heart disease (CHD).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">We included data prospectively collected from 568 patients with CHD. The MAGGIC score is a weighted scoring model that combines 13 different clinical variables, with a score range from low-risk 0 to high-risk 61 points<sup>2</sup>. The MAGGIC score was calculated at the beginning of the study between 2009-2010. Patients were retrospectively followed up to 12/2022 for the occurrence of death and major adverse cardiovascular events (MACE): cardiovascular death, myocardial infarction, heart failure and stroke. Patients with reported symptomatic HF at baseline were excluded. Logistic and Cox regression models were used in time-to-event analysis. NYHA functional&nbsp;class was derived from the metabolic equivalent of tasks.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> At baseline, mean age&nbsp;59&plusmn;10 years, 88% male, 74% dyslipidemia, 64% hypertension, 31% diabetes, BMI 29&plusmn;4 kg/m2, 15% chronic kidney disease, 45% were active or former smokers, 4% stroke, 76% myocardial infarction and 98% had preserved or mildly reduced left ventricular ejection fraction. Regarding medication, more than 75% were treated with renin-angiotensin system inhibitors, beta-blockers, statins and anti-platelets. During follow-up (9.9&plusmn;2.8 years), 38.6% (n=219 patients) met the composite endpoint of MACE, 21.8% had symptomatic CHF and 16.0% myocardial infarction. The mortality rate was 14.8% (n=84), with 4.5% cardiovascular deaths (n=25). The MAGGIC score follows a normal distribution with mean 13.7&plusmn; 5.4 (2-33, min-max). MAGGIC positively correlated with brain natriuretic peptide levels (p&lt;0.007). For each 10-point increase in score, adjusted ORs increase 3.4-fold for death (CI 2.3-4.9, p&lt;0.0001), 1.5-fold for MACE (CI 1.13-2.01, p=0.005), and 1.4-fold for the onset of symptomatic CHF (CI 1.01-1.88, p=0.043). In survival analysis, Kaplan-Meier curves were significantly separated across MAGGIC score (p&lt;0.0001), with an area under the ROC curve of 0.69 for discrimination of patients at higher risk of death. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> MAGGIC score is a powerful predictor of adverse events in CAD patients. MAGGIC score might be potentially helpful in identifying high-risk patients in earlier stages of CHF (ACC/AHA stage B) that benefit from intensification of clinical monitoring and aggressive control of cardiovascular risk factors. </span></span></span></p>

<ol>
	<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">JACC Heart Fail. 2018;6(6):452-462. 2- Eur Heart J. 2012;33(14):1750-7. </span></span></span></span></span></li>
</ol>