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Comparative Study
. 2015 Nov 3;132(18):1710-8.
doi: 10.1161/CIRCULATIONAHA.115.016502. Epub 2015 Sep 8.

The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System: A Taxonomy for Young Women With Acute Myocardial Infarction

Erica S Spatz  1 , Leslie A Curry  1 , Frederick A Masoudi  1 , Shengfan Zhou  1 , Kelly M Strait  1 , Cary P Gross  1 , Jeptha P Curtis  1 , Alexandra J Lansky  1 , Jose Augusto Soares Barreto-Filho  1 , Julianna F Lampropulos  1 , Hector Bueno  1 , Sarwat I Chaudhry  1 , Gail D'Onofrio  1 , Basmah Safdar  1 , Rachel P Dreyer  1 , Karthik Murugiah  1 , John A Spertus  1 , Harlan M Krumholz  2
Affiliations
Comparative Study

The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System: A Taxonomy for Young Women With Acute Myocardial Infarction

Erica S Spatz et al. Circulation. .

Abstract

Background: Current classification schemes for acute myocardial infarction (AMI) may not accommodate the breadth of clinical phenotypes in young women.

Methods and results: We developed a novel taxonomy among young adults (≤55 years) with AMI enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. We first classified a subset of patients (n=600) according to the Third Universal Definition of MI using a structured abstraction tool. There was heterogeneity within type 2 AMI, and 54 patients (9%; including 51 of 412 women) were unclassified. Using an inductive approach, we iteratively grouped patients with shared clinical characteristics, with the aims of developing a more inclusive taxonomy that could distinguish unique clinical phenotypes. The final VIRGO taxonomy classified 2802 study participants as follows: class 1, plaque-mediated culprit lesion (82.5% of women; 94.9% of men); class 2, obstructive coronary artery disease with supply-demand mismatch (2a: 1.4% women; 0.9% men) and without supply-demand mismatch (2b: 2.4% women; 1.1% men); class 3, nonobstructive coronary artery disease with supply-demand mismatch (3a: 4.3% women; 0.8% men) and without supply-demand mismatch (3b: 7.0% women; 1.9% men); class 4, other identifiable mechanism (spontaneous dissection, vasospasm, embolism; 1.5% women, 0.2% men); and class 5, undetermined classification (0.8% women, 0.2% men).

Conclusions: Approximately 1 in 8 young women with AMI is unclassified by the Universal Definition of MI. We propose a more inclusive taxonomy that could serve as a framework for understanding biological disease mechanisms, therapeutic efficacy, and prognosis in this population.

Keywords: classification; myocardial infarction; sex characteristics.

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Figures

Figure 1
Figure 1
Four-step approach to taxonomy development.
Figure 2
Figure 2
Algorithm used to determine the VIRGO classification system.
Figure 3
Figure 3
VIRGO classification system.
See this image and copyright information in PMC

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