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<p>The AHEAD score (Atrial fibrillation, Hemoglobin, Elderly age, Abnormal renal function, and Diabetes) has proven valuable for risk stratification in acute heart failure. However, its prognostic utility specifically in the distinct and high-risk population of patients who develop heart failure after an acute myocardial infarction (AMI) remains to be clarified. Current risk assessment tools in this setting often underrepresent the significant role of systemic inflammation, a key driver of adverse remodeling and poor outcomes post-AMI. To address this gap, we incorporated the Neutrophil-to-lymphocyte ratio (NLR), a robust and readily available marker of inflammatory response. The modified AHEAD-NLR score aims to integrate established clinical risk factors with inflammatory activity, thereby addressing a critical limitation of prior tools and potentially offering a more comprehensive prognostic model. A total of 840 patients with heart failure after AMI were enrolled in this study (age 62.55 ± 11.89&#xa0;years, 81.90% men), with a median follow-up duration of 954&#xa0;days. The predictive efficacy of the AHEAD score for all-cause mortality was evaluated using Cox regression analysis. The mean AHEAD score of study was 1.05 ± 1.04. After adjusting for age, gender, red cell distribution width (RDW), uric acid, serum potassium, D-dimer, Neutrophil-to-lymphocyte ratio (NLR), and Left ventricular ejection fraction(LVEF), the AHEAD score was still significantly associated with an increased risk of all-cause mortality (hazard ratio and 95% confidence interval: 1.270, 1.019–1.582). In addition, when we constructed a new score, AHEAD-NLR, by incorporating the NLR (≥ 8.16) into the AHEAD score, the net reclassification improvement for predicting all-cause mortality was increased by 19.9%. AHEAD score is an independent predictor of all-cause mortality in patients with HF after AMI. AHEAD-NLR score, which integrates clinical risk factors and inflammatory status, further optimizes risk stratification, offering a more comprehensive prognostic tool for this high-risk population.</p>

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The AHEAD-NLR score: a novel inflammatory-comorbidity integrated tool for predicting long-term mortality in patients with heart failure after acute myocardial infarction

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  • 发表日期：

    2026年3月6日

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  • Guoli Lin,
  • Caizhi Dai,
  • Wen Chen

摘要

The AHEAD score (Atrial fibrillation, Hemoglobin, Elderly age, Abnormal renal function, and Diabetes) has proven valuable for risk stratification in acute heart failure. However, its prognostic utility specifically in the distinct and high-risk population of patients who develop heart failure after an acute myocardial infarction (AMI) remains to be clarified. Current risk assessment tools in this setting often underrepresent the significant role of systemic inflammation, a key driver of adverse remodeling and poor outcomes post-AMI. To address this gap, we incorporated the Neutrophil-to-lymphocyte ratio (NLR), a robust and readily available marker of inflammatory response. The modified AHEAD-NLR score aims to integrate established clinical risk factors with inflammatory activity, thereby addressing a critical limitation of prior tools and potentially offering a more comprehensive prognostic model. A total of 840 patients with heart failure after AMI were enrolled in this study (age 62.55 ± 11.89 years, 81.90% men), with a median follow-up duration of 954 days. The predictive efficacy of the AHEAD score for all-cause mortality was evaluated using Cox regression analysis. The mean AHEAD score of study was 1.05 ± 1.04. After adjusting for age, gender, red cell distribution width (RDW), uric acid, serum potassium, D-dimer, Neutrophil-to-lymphocyte ratio (NLR), and Left ventricular ejection fraction(LVEF), the AHEAD score was still significantly associated with an increased risk of all-cause mortality (hazard ratio and 95% confidence interval: 1.270, 1.019–1.582). In addition, when we constructed a new score, AHEAD-NLR, by incorporating the NLR (≥ 8.16) into the AHEAD score, the net reclassification improvement for predicting all-cause mortality was increased by 19.9%. AHEAD score is an independent predictor of all-cause mortality in patients with HF after AMI. AHEAD-NLR score, which integrates clinical risk factors and inflammatory status, further optimizes risk stratification, offering a more comprehensive prognostic tool for this high-risk population.