Abstract

BackgroundThe Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI).MethodsWe enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman’s rank correlation. Cumulative MACE curve was calculated using the Kaplan–Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsDuring a median of 42.3 months (interquartile range 39.3–44.2 months), 16 (2.9 %) were lost to follow-up, and patients experienced 69 (12.9 %) MACEs: 51 (9.6 %) all-cause deaths and 18 (3.4 %) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95 % CI 1.020–1.040; p < 0.001; 3.530; 95 % CI 1.927–6.466; p < 0.001, respectively). Furthermore, Kaplan–Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001].ConclusionsHbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0274-4) contains supplementary material, which is available to authorized users.

Highlights

  • The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assess‐ ment in patients with acute coronary syndrome (ACS)

  • We investigated the predictive value of HbA1c content and GRACE score individually for major adverse cardiac events (MACEs) in patients with ACS but without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) and the potential incremental prognostic value of HbA1c content added to GRACE score

  • Baseline characteristics were shown in Additional file 1: Table S1: Patients in the higher HbA1c levels more often had a prior history of PCI, were lower ejection fraction, estimated glomerular filtration rate (eGFR) level, as well as higher in Monocyte count and LnNT-ProBNP

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Summary

Introduction

The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assess‐ ment in patients with acute coronary syndrome (ACS). We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are diverse in terms of clinical presentation and risk of death or disability. To identify high-risk patients, current guidelines recommend a standardized approach involving validated scoring systems such as the Global Registry of Acute Coronary Events (GRACE) score [1,2,3]. Long-term glycometabolic disorder implies high risk for cardiovascular disease [4, 5]. Previous research found elevated HbA1c content related to increased risk of cardiovascular events [6,7,8]

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