The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial infarction M. Radin a , K. Schreiber b,c , P. Costanzo d , I. Cecchi a , D. Roccatello a , S. Baldovino a , M. Bazzan e , M.J. Cuadrado f , S. Sciascia a, ⁎ ,1 a Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy b Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, United Kingdom c Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark d Cardiology Departiment, S. Giovanni Bosco Hospital, Turin, Italy e UOSD Hematology and Thrombosis Unit, S. Giovanni Bosco Hospital, Turin, Italy. f Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK abstract article info Article history: Received 15 January 2017 Received in revised form 21 February 2017 Accepted 28 February 2017 Available online xxxx Background: Young adults with acute myocardial infarction are a critical group to examine for the purpose of risk factor stratification and modification. In this study we aimed to assess the clinical utility of the adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for the risk stratification of acute myocardial infarction in a cohort of young patients with antiphospholipid syndrome (APS). Methods: The analysis included 83 consecutive APS patients (≤ 50 years old) who presented with arterial or ve- nous thromboembolic events. Data on cardiovascular risk factors and antiphospholipid antibodies (aPL) positiv- ity were retrospectively collected. The aGAPSS was calculated by adding the points corresponding to the risk factors, based on a linear transformation derived from the ß-regression coefficient as follows: 3 for hyperlipidae- mia, 1 for arterial hypertension, 5 for aCL IgG/IgM, 4 for anti-b2 glycoprotein I IgG/IgM and 4 for LA. Results: Higher aGAPSS values were observed in patients with acute myocardial infarction when compared to the others [mean aGAPSS 11.9 (S.D. 4.15, range 4–18) Vs. mean aGAPSS 9.2 (S.D. 5.1, range 1–17); T test: p b 0.05]. Significantly higher aGAPSS values were also seen in patients with acute coronary syndrome compared to pa- tients with a history of peripheral or cerebrovascular arterial thrombotic events [mean aGAPSS 11.9 (S.D. 4.15, range 4–18) Vs. mean aGAPSS 6.7 (S.D. 5.7, range 1–17); T test: P b 0.005]. Conclusions: The aGAPSS is based upon a quantitative score and could aid risk stratifying APS patients younger than 50 years for the likelihood of developing coronary thrombotic events and may guide pharmacological treat- ment for high-risk patients. © 2017 Elsevier B.V. All rights reserved. Keywords: Antiphosphospholipid syndrome APS Acute myocardial infarction GAPSS aGAPSS Risk score Thrombosis 1. Introduction Acute myocardial infarction amongst young patients (for the pur- pose of this work ‘young’ refers to adults younger than 50 years old) is an uncommon event. However, it might represent a life threating situa- tion being associated with a significantly increased mortality and mor- bidity [1,2]. Epidemiological studies have demonstrated that younger adults who develop acute coronary syndrome have an increased prevalence of cardiovascular risk factors, including male gender, smoking, and family history of cardiovascular events [1–3]. Conversely, these patients present a lower prevalence of hypertension and diabetes [2,3]. Angiography is more likely to show a reduced coronary athero- sclerosis when compared with older patients with cardiovascular events [2]. In the setting of underlying systemic autoimmune diseases, premature cardiovascular disease (CVD) deserves even more attention as conditions such as systemic lupus erythematosus (SLE) or rheuma- toid arthritis (RA) have been associated with the development of pre- mature CVD [4]. The latter has even been implemented in the national institute of health and care excellence (NICE) screening questions to risk stratify patients for the development of CVD [5]. Young adults are a critical group to examine for the purpose of risk factor stratification and modification. In this particular patient group, a thorough history for conventional risk factors including a family history International Journal of Cardiology xxx (2017) xxx–xxx ⁎ Corresponding author at: Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154 Turin, Italy. E-mail address: savino.sciascia@unito.it (S. Sciascia). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. IJCA-24750; No of Pages 6 http://dx.doi.org/10.1016/j.ijcard.2017.02.155 0167-5273/© 2017 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: M. Radin, et al., The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial i..., Int J Cardiol (2017), http://dx.doi.org/10.1016/j.ijcard.2017.02.155