Single-Center Retrospective Study of Risk Factors and Predictive Value of Framingham Risk Score of Patients with ST Elevation Myocardial Infarction

Sohail Ikram, MD; Ajay Pachika, MD; Henrike Schuster, MD; Aman Ghotra, MD; Laura Dotson, RT(R), RCIS; Shoaib Akbar, MD; Abdur Rahman Khan, MD


South Med J. 2018;111(4):226-229. 

In This Article

Abstract and Introduction


Objectives: The objective of this study was to identify risk factors and clinical profile of the patients presenting with ST elevation myocardial infarction (STEMI). We further evaluated the utility of the Framingham Risk Score (FRS) in the accurate identification of these patients if used before their coronary event.

Methods: We evaluated the demographic, clinical, and angiographic characteristics of patients admitted with STEMI. We also calculated cardiovascular event risk using the FRS in a subset of patients without prior known coronary artery disease and diabetes mellitus.

Results: A total of 44 patients, predominantly men (75%) and white (80%), with a mean age of 56 ± 10 years, were included in our analysis. Cigarette smoking was the predominant risk factor (83%) followed by hypertension (77%) and dyslipidemia (68%). The calculated FRS in a subset of patients without prior coronary artery disease or diabetes mellitus was 14.1% ± 5.8%. Based on the FRS, 8 (36%) patients had a 10-year risk >20% and 14 (63%) patients had a 10-year risk between 10% and 20%.

Conclusions: In a series of consecutive patients with STEMI, we observed that high FRS was inadequate in correct identification and risk stratification of the majority of patients who had STEMI. Our study underlines the importance of being familiar with multiple risk scores and choosing the most applicable risk score based on the patient's individual characteristics. In addition, it is important to take into consideration the nontraditional risk factors or measurement of coronary artery calcium as a part of the risk assessment algorithm.


Acute coronary syndrome (ACS) is a major cause of mortality and morbidity worldwide, with >683,000 episodes of ACS annually in United States alone.[1] ST elevation myocardial infarction (STEMI) constitutes approximately 25% to 40% of patients who present with ACS and is the leading cause of mortality in this patient population.[1,2] Regional differences exist between the prevalence of risk factors and coronary artery disease (CAD) within the United States.[2] Kentucky ranks ninth in the nation in terms of cardiovascular mortality,[3] with STEMI being one of the major contributors toward adverse mortality.[4] Data regarding risk factors and clinical profile of patients presenting with acute STEMI in this region are lacking, however. We conducted this study to identify the risk factors and clinical profiles of the patients presenting with STEMI at our university hospital in Louisville, Kentucky. We further evaluated the Framingham Risk Score (FRS) in this subset of patients to assess the utility of this score in the identification of patients before their index coronary event who may need intensive risk factor modification.