{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:41:59Z","timestamp":1786725719077,"version":"build-2736575974"},"reference-count":24,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med Princ Pract"],"abstract":"<jats:p>Objectives: The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability. We evaluated whether simple longitudinal clinical and patient-reported measures improved the prediction of major adverse cardiovascular events (MACEs). Subjects and Methods: In this prospective cohort study, 351 patients with first MI were enrolled at a rural tertiary center in South India, of whom 319 formed the analytic cohort. MACE was defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization, as ascertained through hospital records and structured follow-up. Baseline clinical, biochemical, echocardiographic, and interviewer-administered Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and sleep variables were collected during hospitalization and follow-up (1, 6, and 12 months). Cox models were developed in stages, with the GRACE score as a baseline anchor and follow-up variables incorporated using the last available observations. Model performance was assessed using Harrell\u2019s concordance index (C-index), time-dependent area under the curve, and bootstrap validation methods. Results: Over a median follow-up of 5.8 years, 94 patients (29.5%) experienced MACE. The baseline model modestly improved discrimination over GRACE alone (C-index, 0.622 vs. 0.556). The extended model showed higher discrimination (apparent C-index 0.684; optimism corrected 0.660). Follow-up sleep quality, psychosocial symptoms, glycemic measures, and global longitudinal strain contributed to the model, although the estimates were imprecise. Conclusion: Longitudinal follow-up measures provided modest incremental prognostic information beyond a GRACE-based benchmark. Findings are exploratory and require external validation before clinical application.<\/jats:p>","DOI":"10.1159\/000553362","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:27:01Z","timestamp":1783009621000},"page":"1-14","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Psychosocial and Sleep Assessments for Long-Term Cardiovascular Risk Stratification after First Myocardial Infarction in Rural India"],"prefix":"10.1159","author":[{"given":"Mukkirla","family":"Bhargava Sai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8576-8104","authenticated-orcid":false,"given":"Bebeto","family":"Rai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debarshi","family":"Dey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Kiran","family":"Javvaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. Ramnath","family":"Iyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga Sai Visweswar","family":"Kambhampati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Sathish","family":"Ramamurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Rege","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Haloi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalathur Mohan","family":"Ganesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4733-4647","authenticated-orcid":false,"given":"Malleswara","family":"D","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs219"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0482-9"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.1924395"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac249"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2021-216837"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0123215"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2022-001984"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq326"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.111195"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.04.023"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-034135"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.033043"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.115.003162"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31824a58ff"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1038"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(67)90023-9"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004425"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/69.1.239"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4%3c361::AID-SIM168%3e3.0.CO;2-4"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341x.2000.00337.x"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-024-01207-5"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.07.508"}],"container-title":["Medical Principles and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000553362","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:24:52Z","timestamp":1786724692000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000553362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":24,"URL":"https:\/\/doi.org\/10.1159\/000553362","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.32852252","asserted-by":"subject"}]},"ISSN":["1011-7571","1423-0151"],"issn-type":[{"value":"1011-7571","type":"print"},{"value":"1423-0151","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}