Combined GRACE Research Articles

Combinations of bleeding and ischemic risk and their association with clinical outcomes in acute coronary syndrome

BackgroundClinical predictors of future ischemic events in patients with acute coronary syndrome (ACS) are also risk factors for bleeding, with patients often at high-risk of both outcomes. We aimed to define the clinical outcomes and provision of guideline-recommended care in ACS management for different combinations of ischemic and bleeding risk defined using a combined GRACE and CRUSADE score. MethodsA retrospective observational analysis of a national ACS database was performed for patients with ACS admitted to three tertiary centres from January 2010 to March 2016. Patients were stratified into 9 groups based on possible CRUSADE-GRACE risk combinations. Multiple logistic regression was used to estimate adjusted odds ratios (ORs [95% CI]) for outcomes (in-hospital net adverse cardiac events (NACE), in-hospital all-cause mortality, 30-day mortality and treatment strategy). ResultsA total of 17,701 patients were included in the analysis. We observed a graded risk of mortality and adverse events in the high-risk GRACE strata (Groups 3, 6 and 9). Almost a third of patients with ACS were at a ‘dual high-risk’ (Group 9, 32%) and were independently associated with higher in-hospital NACE (composite of cardiac mortality, all-cause bleeding and re-infarction): aOR 6.33 [3.55, 11.29], all-cause mortality: aOR 14.17 [5.27, 38.1], all-cause bleeding: aOR 4.82 [1.96, 11.86], and 30-day mortality: aOR 10.79 [5.33, 21.81]. This group was also the least likely to be offered coronary angiography (aOR 0.24 [0.20, 0.29]) and dual anti-platelet therapy (aOR 0.26 [0.20, 0.34]). ConclusionsOne in five patients presenting with an ACS are high ischemic and high bleeding risk, and these patients are more likely to experience poor clinical outcomes and reduced odds of receiving guideline-recommended therapy.

Impact of Admission Blood Glucose Added on GRACE Risk Score for All-Cause In-Hospital Mortality in Patients with Acute Coronary Syndrome

Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification.
 Objectives: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p <0.05 was considered to be statistically significant.
 Results: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (<11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610).
 Conclusion: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the established risk factors with the GRACE risk score.
 Bangladesh Heart Journal 2018; 33(2) : 94-99

Using combined GRACE and GPS data to investigate the vertical crustal deformation at the northeastern margin of the Tibetan Plateau

In this paper, two types of geodetic measurements, GRACE and GPS, are combined to study the vertical crustal deformation on the northeastern margin of the Tibetan Plateau. The GRACE and GPS derived results show that significant seasonal variations occur at 40 regional continuous GPS stations of the Crustal Movement Observation Network of China (CMONOC). The consistency between the seasonal variations in the GRACE and GPS data can be efficiently enhanced by decreasing the nonlinear deformation in the GPS time series with applying longer observation period. The vertical components of more than 78% of the total number of GPS stations exhibit correlations of more than 0.8 with respect to the corresponding GRACE components, and approximately 73% of the GPS vertical time series exhibit a significant root mean square reduction of approximately 40%, which increases to 60% when corresponding seasonal components derived from the GRACE measurements are subtracted. We consider that the vertical seasonal variations in the study area are caused by mass transfer related to hydrological loading, whereas the horizontal components are related to both mass transfer and other factors, such as the thermal elastic response of the GPS monuments and GPS data processing strategical deficits. These factors distinguish the main differences between the two measurements and exert larger influences in the eastward direction than in the northward direction, contributing to the total displacement. Finally, we use seasonal variations derived from the GRACE results to modify the vertical time series of corresponding GPS campaign stations to mitigate the influences of seasonal loading as much as possible in the dispersed time series. The results show that this modification can significantly reduce the scatter of campaign time series and improve the derived velocities uncertainties remarkably.

Natriuretic peptides, nitrite/nitrate and superoxide dismutase have additional value on top of the GRACE score in prediction of one-year mortality and rehospitalisation for heart failure in STEMI patients — Multiple biomarkers prospective cohort study

BackgroundBlood-based biomarkers have a prognostic value in patients with myocardial infarction. The aim of our prospective observational cohort study was to evaluate the prognostic value of biomarkers of different pathophysiological pathways for the occurrence of 1-year all-cause mortality and hospitalisation due to acute heart failure. Methods and resultsIn 593 patients with ST-segment elevation MI (STEMI) treated by primary PCI, biomarkers were evaluated at 24h after MI onset. A minimum of three-year follow-up was achieved in all patients. The combination of 1-year all-cause mortality and hospitalisation due to heart failure was the primary endpoint. A cohort for validation of our combined GRACE–natriuretic peptide (NP) score included 667 STEMI patients.The primary endpoint was reached in 9.3% of patients. Among 21 biomarkers, only B-type natriuretic peptide (BNP), NT-proBNP, superoxide dismutase and nitrite/nitrate, added to clinical GRACE score led to a significant increase in the area under the curve of C statistics, in comparison to GRACE alone (tested by Delong's test). Continuous net reclassification improvement and integrated discrimination index demonstrated an improved reclassification and discrimination of the GRACE model for SOD, BNP and NT-proBNP, and improved reclassification for nitrite/nitrate. Consistent results for this new combined prognostic model GRACE–NP were found also for a validation cohort. ConclusionsThe levels of NP have an additional value to the prognostic properties of the GRACE score for the prediction of the combined endpoint of one-year mortality or hospitalisation for AHF. Nitrite/nitrate and SOD are strong prognostic factors, even on top of the GRACE score.

Canadian gravimetric geoid model 2010

A new gravimetric geoid model, Canadian Gravimetric Geoid 2010 (CGG2010), has been developed to upgrade the previous geoid model CGG2005. CGG2010 represents the separation between the reference ellipsoid of GRS80 and the Earth’s equipotential surface of $$W_0=62{,}636{,}855.69~\mathrm{m}^2\mathrm{s}^{-2}$$ . The Stokes–Helmert method has been re-formulated for the determination of CGG2010 by a new Stokes kernel modification. It reduces the effect of the systematic error in the Canadian terrestrial gravity data on the geoid to the level below 2 cm from about 20 cm using other existing modification techniques, and renders a smooth spectral combination of the satellite and terrestrial gravity data. The long wavelength components of CGG2010 include the GOCE contribution contained in a combined GRACE and GOCE geopotential model: GOCO01S, which ranges from $$-20.1$$ to 16.7 cm with an RMS of 2.9 cm. Improvement has been also achieved through the refinement of geoid modelling procedure and the use of new data. (1) The downward continuation effect has been accounted accurately ranging from $$-22.1$$ to 16.5 cm with an RMS of 0.9 cm. (2) The geoid residual from the Stokes integral is reduced to 4 cm in RMS by the use of an ultra-high degree spherical harmonic representation of global elevation model for deriving the reference Helmert field in conjunction with a derived global geopotential model. (3) The Canadian gravimetric geoid model is published for the first time with associated error estimates. In addition, CGG2010 includes the new marine gravity data, ArcGP gravity grids, and the new Canadian Digital Elevation Data (CDED) 1:50K. CGG2010 is compared to GPS-levelling data in Canada. The standard deviations are estimated to vary from 2 to 10 cm with the largest error in the mountainous areas of western Canada. We demonstrate its improvement over the previous models CGG2005 and EGM2008.

The understanding of length-of-day variations from satellite gravity and laser ranging measurements

P>The change in the rate of the Earth's rotation, length-of-day (LOD), is principally the result of movement and redistribution of mass in the Earth's atmosphere, oceans and hydrosphere. Numerous studies on the LOD excitations have been made from climatological/hydrological assimilation systems and models of the general circulation of the ocean. However, quantitative assessment and understanding of the contributions to the LOD remain unclear due mainly to the lack of direct global observations. In this paper, the total Earth's surface fluids mass excitations to the LOD at seasonal and intraseasonal timescales are investigated from the Jet Propulsion Laboratory Estimating Circulation and Climate of the Ocean (ECCO) model, the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis and the European Center for Medium-Range Weather Forecasts (ECMWF) Re-analysis (ERA)-Interim, GRACE-derived surface fluids mass and the spherical harmonics coefficient C-20 from the satellite laser ranging (SLR) as well as combined GRACE+SLR solutions, respectively. Results show that the GRACE and the combined GRACE and SLR solutions better explain the geodetic residual LOD excitations at annual and semi-annual timescales. For less than 1 yr timescales, GRACE-derived mass is worse to explain the geodetic residuals, whereas SLR agrees better with the geodetic residuals. However, the combined GRACE and SLR results are much improved in explaining the geodetic residual excitations at intraseasonal scales.

Alpha lipoic acid combined analgecine on treatrment of chemotherapy in duced peripheral neuropathy

Objective To study a-lipoic acid and then appropriate treatment of co-ex chemotherapy induced peripheral neuropathy clinical efficacy. Methods From January 2008 to 2010 in January 246 patients treated in chemotherapy induced peripheral neuropathy were randomly divided into treatment group 126 cases;the control group of 120 cases; treatment group was a-lipoic acid treatment combined grace and then apply the control group were Methylcobalamin Vitamin B12 Injection and treatment; clinical efficacy. Results The total effective of 120 cases, total effective rate 95.23% , the efficiency of the control group was 99 cases, 82. 5%;group total effective rate was P ＜ 0. 05 significant difference. Conclusion A-lipoic acid and then appropriate treatment of co-ex peripheral neuropathy caused by chemotherapy can significantly increase the sensory nerve,motor nerve conduction velocity, improve clinical symptoms. a-lipoic acid and then appropriate treatment of coex chemotherapy induced peripheral neuropathy is effective, the clinical effect is synergistic effect. During treatment, there was no serious adverse reactions, but with high security. Key words: Alpha-lipoic acid; Analgecine; Chemotherapy induced peripheral neuropathy; Effect Analysis

Estimation of steric sea level variations from combined GRACE and Jason-1 data

We estimate the mean steric sea level variations over the 60°S–60°N oceanic domain for the recent period (from August 2002 to April 2006), by combining sea level data from Jason-1 altimetry with time-variable gravity data from GRACE. The observed global mean sea level change from satellite altimetry results in total from steric plus ocean mass change. As GRACE measurements averaged over the ocean represents the ocean mass change component only, the difference between GRACE and altimetry observations provides an estimate of the mean steric sea level. Two different sets of GRACE geoid solutions (the GRGS EIGEN-GL04 and the GFZ EIGEN-GRACE04S products) have been used. Each GRACE data set ranges over approximately 3 yr or more (August 2002–April 2006 for the GRGS geoids and February 2003–February 2006 for the GFZ geoids).We first focus on the seasonal variations. The two GRACE data sets agree very well in terms of mean annual mass variation, both in amplitude (approximately 7.3 mm equivalent sea level) and phase (maximum on October 14). For both time spans, Jason-1 sea level minus GRACE ocean mass has an annual amplitude of approximately 5.8 mm with a maximum on March 11. The latter signal compares well with the steric annual sea level estimated from the World Ocean 2004 climatology and the Ishii et al. [M. Ishii, M. Kimoto, K. Sakamoto, and S.I. Iwasaki, Steric sea level changes estimated from historical ocean subsurface temperature and salinity analyses, Journal of Oceanography, 62 (2) (2006) 155–170.] ocean temperature data. We also examine the interannual fluctuations of the Jason-1 minus GRACE sea level. The two resulting steric sea level time series (based on the two GRACE data sets) agree well. The inferred steric sea level curve exhibits an increasing trend during the last 3.5 yr (August 2002–April 2006), of the same order of magnitude as the 1993–2003 steric sea level trend computed with in situ hydrographic data. However, over the last 3.5 yr, we note a strong discrepancy between altimetry minus GRACE and in situ-based steric sea level trend, the latter exhibiting a negative slope. The cause for such a discrepancy is yet unknown but may be related to inadequate sampling of in situ ocean temperature measurements.

How to reach a few percent level in determining the Lense–Thirring effect?

In this paper we explore the possibility of suitably combining the nodes Ω of the existing geodetic LAGEOS, LAGEOS II and Ajisai laser-ranged satellites and of the radar altimeter Jason–1 satellite in order to increase the accuracy in testing the general relativistic gravitomagnetic Lense–Thirring secular effect in the gravitational field of the Earth. The proposal of introducing Ajisai and Jason–1 in such a combination comes from the expected benefits which could be obtained in reducing the aliasing secular impact of the classical part of the terrestrial gravitational field. According to the recently released EIGEN-CG01C combined GRACE + CHAMP + terrestrial gravimetry/altimetry Earth gravity model, the impact of the static part of the mismodelled even zonal harmonics of geopotential, which represent the major source of systematic error, amounts to 1.6%, at 1−σ level. It is better than the error which could be obtained with a two-node LAGEOS-LAGEOS II only combination (6% at 1−σ). Moreover, the proposed combination would be insensitive also to the secular variations of the low-degree even zonal harmonics, contrary to the LAGEOS-LAGEOS II only combination. Such variations could be a serious limiting factor over observational time spans many years long. The price to be paid for this improvements of the systematic error of gravitational origin is represented by the non-conservative forces introduced along with the new orbital elements. However, they would induce periodic perturbations, contrary to the gravitational noise. A major concern would be the assessment of the impact of the non-conservative accelerations on the Jason–1 node. According to the present-day force models, the mismodelling in the non-conservative forces would, at worst, induce an aliasing periodic signal with an amplitude of 4% of the Lense-Thirring effect over a time span of 2 years. However, an observational time span of just some years could safely be adopted in order to fit and remove the residual long–period non-gravitational signals affecting Jason’s node, which, in the case of the direct solar radiation pressure, have a main periodicity of approximately 120 days. Of course, the possibility of getting time series of the Jason’s node some years long should be demonstrated in reality.