Common Heart Risk Scores Miss Many First Heart Attacks, Mount Sinai Study Finds

Overview

• Researchers reviewed 474 patients under age 66 with no known coronary disease who had a first myocardial infarction at two Mount Sinai hospitals between January 2020 and July 2025, simulating risk assessment two days before the event.
• Using the widely applied ASCVD 10-year calculator, 45% of patients would have been classified as low or borderline risk and not flagged for preventive therapy or testing.
• The newer PREVENT calculator would have labeled 61% as low or borderline risk despite an imminent heart attack.
• Sixty percent of patients reported initial symptoms less than 48 hours before their infarction, indicating symptom-based triage often comes too late for prevention.
• The brief report, published November 21 in JACC: Advances by authors including Anna S. Mueller and Amir Ahmadi, calls for prospective validation and evaluation of imaging-based screening while noting limits of a single health system and a younger cohort.