Aortic valve sclerosis in patients with acute myocardial infarction: a marker of increased risk of re-infarction

Background: Patients with acute myocardial infarction (AMI) are at increased risk of recurrent cardiovascular events. Aortic valve sclerosis (AVSc), which reflects a systemic damage, may serve as a marker of risk. The aim of the present study is to better stratify sub-groups of AMI patients with specific probabilities of recurrent AMI and to evaluate the importance of AVSc in this setting. Methods: We analyzed 2120 AMI patients admitted at Centro Cardiologico Monzino (2010-2019) who underwent echocardiographic evaluation for AVSc assessment. Topological data analysis (TDA) was used to stratify sub-groups of patients experiencing recurrent AMI and a random forest procedure to evaluate the importance of baseline clinical characteristics. Kaplan-Meier and Cox regression analyses were used to evaluate recurrent AMI incidence, for up to 10 years. Results: TDA highlighted the presence of 8 clusters of patients with specific risks of recurrent AMI. The evaluation of time-to-event curves allowed us to combine these clusters into three super-clusters (i.e., low-, moderate-, and high-risk) and a random forest procedure showed AVSc as the most relevant variable to discriminate the three classes of risk. AVSc was detected in 1000 (47%) patients. After full adjustment, we found a significant association of AVSc with recurrent AMI (hazard ratio (HR) 1.42, 95%CI:1.03-1.97). Stratifying by age, this association was significant only for patients younger than 75 years after 5 years of follow-up (HR 1.59, 95%CI:1.03-2.46). Conclusions: AVSc has been identified to be the most relevant variable to recognize patients at high risk of recurrent AMI. AVSc is frequently detected in AMI patients and is strongly associated with recurrent AMI, especially in patients younger than 75 years old. The presence of AVSc should be taken into consideration to improve the risk stratification and clinical management of AMI patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Italian Ministry of Health funds (Ricerca Finalizzata: GR-2019-12370560 and GR-2018-12366423) and Ricerca Corrente. P.P. is supported by Fondazione Gigi e Pupa Ferrari ONLUS (FPF-14). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Institutional Review Board and by the Ethical Committee of CCM (R1348/20-CCM 1418). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying this article will be shared upon reasonable request to the corresponding author.