Global Registry Of Acute Coronary Events Research Articles

The Predictive Value of Geriatric Nutritional Risk Index Combined with the GRACE Score in Predicting the Risk of One Year Poor Prognosis in Elderly Patients with Non-ST Segment Elevation Myocardial Infarction After PCI.

As a nutritional indicator, a lower level of geriatric nutritional risk index (GNRI) has been suggested as a predictor for poor prognosis in acute coronary syndrome (ACS). However, whether GNRI could improve the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis in elderly patients with non-ST segment elevation myocardial infarction (NSTEMI) after PCI remains unclear. A total of 446 elderly patients with NSTEMI after percutaneous coronary intervention (PCI) were consecutively enrolled. Patients were divided into major adverse cardiovascular and cerebrovascular events (MACCE) group and control group according to the occurrence of MACCE during one year follow up. The clinical parameters including GNRI were compared to investigate the predictors for MACCE. The performance after the addition of GNRI to the GRACE score for predicting MACCE was determined. A total of 68 patients developed MACCE. In unadjusted analyses, the rate of MACCE was significantly higher in the 93.8<GNRI <102.7 group and GNRI ≤ 93.8 group versus GNRI ≥ 102.7 group. The logistics regression model showed that age, GNRI, and GRACE score were independent predictors for MACCE in elderly patients with NSTEMI after PCI. The addition of the GNRI to the GRACE score significantly improved the prediction of MACCE in elderly patients with NSTEMI after PCI, increasing the C-index from 0.792 to 0.885 (p < 0.001); the NRI was 0.094 (95% CI, 0.004-0.177, p < 0.001), and the IDI was 0.011 (95% CI, 0.000-0.023, p < 0.001). Combining GNRI and GRACE score could significantly improve the predictive value of one year MACCE in elderly patients with NSTEMI after PCI. By using this combined new risk model, we could easily identify the high-risk populations in clinical practice, so as to better monitor and manage them.

Using Principles of Digital Development for a Smartphone App to Support Data Collection in Patients With Acute Myocardial Infarction and Physical Activity Intolerance: Case Study.

Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals. We aimed to describe the process of developing a mobile app to validate the nursing diagnosis "intolerance to physical activity" in patients with acute myocardial infarction. We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index. We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%). We developed a mobile app for validating the diagnosis of "activity intolerance." Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs.

Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients.

The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ± 13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUCASI = 0.80 vs. AUCSI = 0.72, P < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUCASI = 0.80 vs. AUCGRACE = 0.85, P < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUCASI = 0.80 vs. AUCTIMI = 0.84, P < 0.001). The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.

Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute ST-segment elevation myocardial infarction.

To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients. This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score. The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027). The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.

A Prediction Model Based on Systemic Immune-Inflammatory Index Combined with Other Predictors for Major Adverse Cardiovascular Events in Acute Myocardial Infarction Patients.

To evaluate the prognostic value of the systemic immune-inflammatory index (SII) for predicting in-hospital major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI) and establish a relevant nomogram. This study included 954 AMI patients. We examined three inflammatory factors (SII, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR)) to see which one predicts in-hospital MACEs better. The predictors were subsequently screened using bidirectional stepwise regression method, and a MACE nomogram was constructed via logistic regression analysis. The predictive value of the model was evaluated using the area under the curve (AUC), sensitivity and specificity. In addition, the clinical utility of the nomogram was evaluated using decision curve analysis. We also compared the nomogram with the Global Registry of Acute Coronary Events (GRACE) scoring system. 334 (35.0%) patients had MACEs. The SII (AUC =0.684) had a greater predictive value for in-hospital MACEs in AMI patients than the PLR (AUC =0.597, P<0.001) or NLR (AUC=0.654, P=0.01). The area under the curve (AUC) of the SII-based multivariable model for predicting MACEs, which was based on the SII, Killip classification, left ventricular ejection fraction, age, urea nitrogen (BUN) concentration and electrocardiogram-based diagnosis, was 0.862 (95% CI: 0.833-0.891). Decision curve and calibration curve analysis revealed that SII-based multivariable model demonstrated a good fit and calibration and provided positive net benefits than the model without SII. The predictive value of the SII-based multivariable model was greater than that of the GRACE scoring system (P<0.001). SII is a promising, reliable biomarker for identifying AMI patients at high risk of in-hospital MACEs, and SII-based multivariable model may serve as a quick and easy tool to identify these patients.

The Correlation Between GRACE Risk Score and SYNTAX Angiographic Score in Acute Coronary Syndrome: A Cross-Sectional Study

Background: The Global Registry of Acute Coronary Events (GRACE) is used in patients with acute coronary syndrome (ACS) to stratify the risk of mortality. The Synergy Between Percutaneous Coronary Intervention (SYNTAX) score explains the extent of coronary artery disease (CAD) and guides to an appropriate treatment strategy. Objectives: This study aimed to determine the correlation between GRACE and SYNTAX scores. Methods: A total of 101 ACS patients were recruited in this case-control study. Coronary angiography (CA) was performed for all of the participants. Correlation analysis was performed to investigate the relationship between GRACE risk and SYNTAX angiographic scores. Results: A total of 83 men and 18 women who had ACS with an average age of 57.2 ± 11.6 years (minimum of 33 and maximum of 89 years) were investigated. The SYNTAX angiographic score and the GRACE risk score for participants of this study were 15.09 ± 5.87 and 114.47 ± 26.2, respectively. A strong positive correlation, which was statistically significant, was demonstrated between the GRACE risk score and the SYNTAX angiographic score (r = 0.867, P &lt; 0.001) Conclusions: Our findings point out a significant strong positive correlation exists between GRACE risk score and SYNTAX angiographic score in patients with unstable angina (UA), ST-elevation myocardial infarction (STEMI), or non-ST elevation myocardial infarction (NSTEMI).

The Effect of Beta-Blocker Post-Myocardial Infarction With Ejection Fraction >40% Pooled Analysis From Seven Arabian Gulf Acute Coronary Syndrome Registries.

The use of beta-blockers (BB) in reduced left ventricular ejection fraction (LVEF) post-myocardial infarction (MI) is associated with reduced 1-year mortality, while their role in patients with mid-range and preserved LVEF post-MI remains controversial. We studied 31,620 patients who presented with acute coronary syndrome (ACS) enrolled in seven Arabian Gulf registries between 2005 and 2017. Patients with LVEF ≤40% were excluded. The remaining cohort was divided into two groups: BB group (n = 15,541) and non-BB group (n = 2,798), based on discharge medications. Patients in the non-BB group were relatively younger (55.3 vs. 57.4, P = .004) but higher risk at presentation; with higher Global Registry of Acute Coronary Events (GRACE) score (119.2 vs 109.2, P < .001), higher percentage of cardiogenic shock (3.5 vs 1.4%, P < .001), despite lower prevalence of comorbidities, such as hypertension and hyperlipidemia. BB use was associated with lower 1-year mortality in a multivariate logistic regression analysis, adjusting for major confounders [adjusted odds ratio (OR): 0.71 (95% CI 0.51-0.99)]. This remained the case in a sensitivity analysis using propensity score matching [adjusted OR: 0.34 (95% CI 0.16-0.73)]. In this study, using Arabian Gulf countries registries, the use of BB after ACS with LVEF >40% was independently associated with lower 1-year mortality.

Correlation of Serum Neutrophil Gelatinaseassociated Lipocalin with Clinical Severity Score in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Acute Coronary Syndrome (ACS) is a term that encompasses various clinical presentations such as ST-Segment Elevation Myocardial Infarction (STEMI), Non STEMI (NSTEMI), or unstable angina. Neutrophil Gelatinase-associated Lipocalin (NGAL), also known as lipocalin-2, belongs to the lipocalin category of extracellular proteins. Recent research indicates that NGAL levels are increased in different cardiac situations, regardless of the presence of acute renal injury. Aim: To compare the levels of serum NGAL and Global Registry of Acute Coronary Events (GRACE) scores between cases with ACS and Angio-negative cases, and to study the correlation of serum NGAL with the GRACE score (clinical severity score) in ACS patients. Materials and Methods: A cross-sectional study was conducted with 128 patients at the Department of Biochemistry, MKCG Medical College and Hospital, Berhampur, Odisha, India, presenting to the Cardiac Emergency Department from November 2020 to August 2021. Coronary Angiograms (CAG) were done to confirm the presence of Coronary Artery Disease (CAD), and patients were grouped accordingly as Group-1 with ACS patients and Group-2 with angiogram-negative cases. Apart from the routine work-up, including serum urea and creatinine, serum electrolytes, fasting blood sugar, lipid profile, and management, all patients underwent determination of serum NGAL levels and GRACE score at admission. The data were analysis using student’s t-test and Pearson’s correlation test. Results: Among the 128 participants (64 cases in Group-1 and 64 cases in Group-2), Group-1 comprised 37 cases of STEMI, 26 cases of NSTEMI, and one case of unstable angina. Serum NGAL levels were significantly elevated in patients with CAGproven ACS (140.89±56.47 ng/mL) without any renal dysfunction, sepsis, or overt infection compared to patients without CAD on CAG (52.01±18.39 ng/mL) (p&lt;0.0001). The serum NGAL level exhibited a positive correlation of 0.359 (p=0.004) with the severity of ACS, as measured by the GRACE score. Conclusion: The present study suggests that serum NGAL in patients with ACS may serve as a potential novel biomarker for risk stratification and predicting the severity of the disease.

Use of Global Registry of Acute Coronary Events (GRACE) scoring in the management of chest pain patients with suspected acute coronary syndrome in the emergency department

Amaç: Akut koroner sendrom (AKS), genellikle koroner kan akımındaki ani bir düşüşe bağlı akut miyokard iskemisi ve/veya enfarktüs ile uyumlu bir dizi rahatsızlığa değinen kullanışlı bir operasyonel terim olarak geliştirilmiştir. Global Registry of Acute Coronary Events (GRACE), Non ST elevasyonlu Miyokart infarktüsü(NSTEMİ) ve anstabil anjina pektoris ile başvuran hastaların sonuçlarını izlemek üzere tasarlanmış uluslararası bir veritabanıdır. Bu çalışmanın amacı acil serviste AKS düşünülerek takip edilen göğüs ağrılı hastalarda GRACE skorlamasının, ayaktan hastalarda majör kardiyak olayların öngörülmesinde kullanımını belirlemek ve hasta yönetiminde uygulandığında hastanın acil serviste takip süresi ve tetkik sayıları üzerine olabilecek etkilerini değerlendirmektir.&#x0D; &#x0D; Gereç ve Yöntemler: Çalışmaya, acil servisimize başvuran yetişkin (&gt;18 yaş), hastanede veya hastane öncesinde kardiyak kökenli göğüs ağrısı şüphesi bulunan hastalar dahil edilerek, klinik, anamnez verileri ve koroner arter hastalığı risk faktörleri prospektif olarak kaydedilmiştir. GRACE skoru verilerine sahip hastaların bilgileri İos işletim sisteminde çalışan “The GRACE 2.0 ACS Risk Calculator app” ile yapılmıştır. Tüm hastalar ilk başvurudan itibaren 6 hafta içinde majör kardiyak olaylar açısından (akut miyokart enfarktüsü, perkutan koroner girişim, koroner arter bypass cerrahisi ve herhangi bir sebepten ölüm) takip edilmiştir. &#x0D; &#x0D; Bulgular: Acil servise başvuran toplam 167 hastanın 117’si erkek (%70,1) ve 50’si kadın (%29,9)’dı. GRACE skorlarının sayısal değerleri ile majör kardiyak olay gelişmesi arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (p=0.358, t=-,922). Öte yandan iki troponin değeri negatif olan hastalarla diğer hastalar arasında GRACE skorlarının farklılığı değerlendirildiğinde arada anlamlı fark bulunmuştur(p=0.02). Troponin değeri iki kez negatif bulunan hastalar ile ikinci ve üçüncü troponin değeri pozitif bulunan hastaların acil serviste takip süreleri karşılaştırıldığında arada anlamlı fark bulunmuştur(p

Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction

Background The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. Methods This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. Results During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. Conclusion Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.

Prognostic utility of a multi-biomarker panel in patients with suspected myocardial infarction

Abstract Background The accurate identification of patients with high cardiovascular risk in suspected myocardial infarction (MI) is an unmet clinical need. Therefore, we sought to investigate the prognostic utility of a multi-biomarker panel with 29 different biomarkers in in 748 consecutive patients with symptoms indicative of MI using a machine learning-based approach. Methods Incident major cardiovascular events (MACE) were documented within 1 year after the index admission. The selection of the best multi-biomarker model was performed using the least absolute shrinkage and selection operator (LASSO). The independent and additive utility of selected biomarkers was compared to a clinical reference model and the Global Registry of Acute Coronary Events (GRACE) Score, respectively. Findings were validated using internal cross-validation. Results Median age of the study population was 64 years. At 1 year of follow-up, 160 cases of incident MACE were documented. 16 of the investigated 29 biomarkers were significantly associated with 1-year MACE. Three biomarkers including NT-proBNP (HR per SD 1.24), Apolipoprotein A-I (Apo A-I; HR per SD 0.98) and kidney injury molecule-1 (KIM-1; HR per SD 1.06) were identified as independent predictors of 1-year MACE. Although the discriminative ability of the selected multi-biomarker model was rather moderate, the addition of these biomarkers to the clinical reference model and the GRACE score improved model performances markedly (∆C-index 0.047 and 0.04, respectively). Conclusion NT-proBNP, Apo A-I and KIM-1 emerged as strongest independent predictors of 1-year MACE in patients with suspected MI. Their integration into clinical risk prediction models may improve personalized risk stratification. Graphical abstract Prognostic utility of a multi-biomarker approach in suspected myocardial infarction. In a cohort of 748 patients with symptoms indicative of myocardial infarction (MI) to the emergency department, we measured a 29-biomarker panel and performed regressions, machine learning (ML)-based variable selection and discriminative/reclassification analyses. We identified three biomarkers as top predictors for 1-year major adverse cardiovascular events (MACE). Their integration into a clinical risk prediction model and the Global Registry of Acute Coronary Events (GRACE) Score allowed for marked improvement in discrimination and reclassification for 1-year MACE. Apo apolipoprotein; CRP C-reactive protein; CRS clinical risk score; ECG electrocardiogram; EN-RAGE extracellular newly identified receptor for advanced glycation end-products binding protein; FABP fatty acid–binding protein; GS Grace Score; hs-cTnI high-sensitivity cardiac troponin I; KIM-1 kidney injury molecule–1; LASSO least absolute shrinkage and selection operator; MACE major adverse cardiovascular events; MI myocardial infarction; NRI net reclassification improvement; NT-proBNP N-terminal prohormone of brain natriuretic peptide.

Time to coronary catheterization in patients with non-ST-segment elevation acute coronary syndrome and high Global Registry of Acute Coronary Events score.

Current guidelines recommend an early (<24 h) invasive coronary angiography (ICA) strategy in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with Global Registry of Acute Coronary Events (GRACE) score over 140. Evidence for this recommendation is based on older trials. Between 1 February 2016 and 31 July 2021, 1767 patients with a primary diagnosis of NSTE-ACS without indication for urgent ICA underwent ICA during index hospitalization. Six hundred and fifty-five patients underwent early invasive ICA (within 24 h) and 1112 underwent late ICA (between 24 h and 1 week). One hundred and seven patients had a GRACE risk score of 140 or above and 1660 had a GRACE risk score under 140. The primary composite outcome was all-cause mortality, stroke, and recurrent myocardial infarction (MI). Median time from admission to ICA was 13.3 h (IQR 6.0-20.6) for the early group and 59.9 h for the late group (IQR 23.5-96.3). There was no difference between the early and late ICA groups in the primary composite outcome [late catheterization >24 h hazard ratio 1.196, 95% confidence interval (CI) 0.969-1.475, P -value 0.096]. A multivariable Cox regression model for the composite outcome revealed no difference between the early and late ICA groups (late catheterization >24 h hazard ratio 1.0735, 95% CI 0.862-1.327, P -value 0.512) with no effect for performing early ICA in patients with GRACE score over 140 (hazard ratio 1.291, 95% CI 0.910-1.831, P -value 0.151). An early ICA strategy in patients with NSTE-ACS patients and GRACE risk score over 140, compared with late ICA, was not associated with improved composite outcome of death, myocardial infarction, and stroke at 1 year.

“A Longitudinal Study of KILLIP Class, Thrombolysis In Myocardial Infarction (TIMI), Global Registry Of Acute Coronary Events (GRACE), Risk Scores For Prediction Of Cardio Vascular Outcomes In Patients Presenting With Acute ST Elevation Myocardial Infarction in a Tertiary Care Centre.”

“A Longitudinal Study of KILLIP Class, Thrombolysis In Myocardial Infarction (TIMI), Global Registry Of Acute Coronary Events (GRACE), Risk Scores For Prediction Of Cardio Vascular Outcomes In Patients Presenting With Acute ST Elevation Myocardial Infarction in a Tertiary Care Centre.”

Serum cystatin C predicts the risk of non-ST-elevation acute coronary syndrome

ObjectiveInflammation markers have been proposed as the predictors of adverse cardiac events in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This study aimed to investigate prognostic value of serum cystatin C (Cys-C) for NSTE-ACS patients.MethodsCys-C, neutrophil to lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hsCRP) were examined in 212 NSTE-ACS patients and 60 controls. Global registry of acute coronary events (GRACE) score and major adverse cardiac events (MACE) in NSTE-ACS patients were recorded.ResultsCys-C level in the serum was significantly higher in NSTE-ACS patients than in control, and was positively correlated with hsCRP level and NLR as well as GRACE score at admission and 6 months after discharge in NSTE-ACS patients. Serum Cys-C level was identified as a new predictor of MACE.ConclusionSerum Cys-C level may be an inflammation biomarker in patients with NSTE-ACS, and could be used as an independent predictor of MACE.

Adding the value of the Charlson Comorbidity Index to the GRACE score for mortality prediction in acute coronary syndromes.

Scarce and conflicting data still exist about the role of the Charlson Comorbidity Index (CCI) when added to the traditional Global Registry of Acute Coronary Events (GRACE) risk score for outcome prediction in patients with acute coronary syndrome (ACS). All consecutive admissions due to ACS, from 1 January 2018 to 31 December 2020 were retrospectively reviewed from an internal database of a tertiary cardiac center in Salerno (Italy). Logistic and Cox proportional regression analyses were performed in order to assess the contribution of the CCI on 30-day and long-term mortality. The CCI adding value to the GRACE score was analyzed with several measures of improvement in discrimination: increase in the area under the receiver-operating characteristic curve (AUC), the integrated discrimination improvement (IDI), and the categorical and continuous net reclassification improvement (cNRI) more than 0. Robustness of the results was assessed through an internal validation procedure with bootstrapping. One thousand three hundred and ten patients were identified. The median age was 68 (58-78) years. One hundred and twenty (9.2%) and 113 (9.5%) deaths occurred, respectively, during the first 30 days from admission and during long-term follow-up (median follow-up time: 13 months; interquartile range: 9-24). After multivariate regression analysis, the CCI was not associated with short-term mortality, while it was significantly and independently associated with long-term mortality along with the GRACE score (hazard ratio: 1.34, 95% confidence interval: 1.22-1.47; P  < 0.001). An additive effect of CCI with the GRACE risk score was observed in predicting long-term mortality: AUC from 0.768 to 0.819 ( P  = 0.003), category-based NRI: 0.215, cNRI>0: 0.669 ( P  < 0.001), IDI: 0.066 ( P  < 0.001). The CCI is a predictor of long-term mortality and improves risk stratification of patients with ACS over the GRACE risk score.

Machine learning for predicting intrahospital mortality in ST-elevation myocardial infarction patients with type 2 diabetes mellitus

In an era of increasing need for precision medicine, machine learning has shown promise in making accurate acute myocardial infarction outcome predictions. The accurate assessment of high-risk patients is a crucial component of clinical practice. Type 2 diabetes mellitus (T2DM) complicates ST-segment elevation myocardial infarction (STEMI), and currently, there is no practical method for predicting or monitoring patient prognosis. The objective of the study was to compare the ability of machine learning models to predict in-hospital mortality among STEMI patients with T2DM. We compared six machine learning models, including random forest (RF), CatBoost classifier (CatBoost), naive Bayes (NB), extreme gradient boosting (XGBoost), gradient boosting classifier (GBC), and logistic regression (LR), with the Global Registry of Acute Coronary Events (GRACE) risk score. From January 2016 to January 2020, we enrolled patients aged > 18 years with STEMI and T2DM at the Affiliated Hospital of Zunyi Medical University. Overall, 438 patients were enrolled in the study [median age, 62 years; male, 312 (71%); death, 42 (9.5%]). All patients underwent emergency percutaneous coronary intervention (PCI), and 306 patients with STEMI who underwent PCI were enrolled as the training cohort. Six machine learning algorithms were used to establish the best-fit risk model. An additional 132 patients were recruited as a test cohort to validate the model. The ability of the GRACE score and six algorithm models to predict in-hospital mortality was evaluated. Seven models, including the GRACE risk model, showed an area under the curve (AUC) between 0.73 and 0.91. Among all models, with an accuracy of 0.93, AUC of 0.92, precision of 0.79, and F1 value of 0.57, the CatBoost model demonstrated the best predictive performance. A machine learning algorithm, such as the CatBoost model, may prove clinically beneficial and assist clinicians in tailoring precise management of STEMI patients and predicting in-hospital mortality complicated by T2DM.

Right ventricular-pulmonary artery coupling and in-hospital mortality of patients with first acute coronary syndrome

Abstract Background Right ventricular-pulmonary artery (RV-PA) coupling is a means of indexing RV performance to the existent RV afterload. Although non-invasive analysis of RV-PA coupling is a well-recognized prognosticator in chronic RV pressure overload conditions such as heart failure and pulmonary hypertension, its impact in patients with myocardial infarction and acute elevations in RV afterload remains undetermined. Aim This study sought to investigate the associations and short term prognostic value of RV-PA coupling in patients with first acute coronary syndrome (ACS), as assessed by two standard echocardiographic measurements: tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Methods A total of 300 consecutive patients with first ACS (mean age 61.2±11.8 years, 74% males) were prospectively enrolled. A comprehensive transthoracic echocardiographic assessment was undertaken within 24 hours after revascularization. In-hospital mortality was the study endpoint. The study population was dichotomized according to the optimal TAPSE/PASP cut-off, as determined by receiver-operating characteristic curve analysis. Univariable and multivariable logistic regression analysis was performed to determine predictors of impaired TPASE/PASP and the association of TAPSE/PASP with in-hospital mortality. To further assess the incremental prognostic value of TAPSE/PASP over a baseline model the change in x² was assessed using the likelihood ratio test. Results A total of 23 (7.7%) patients died in-hospital despite successful revascularization. The optimal cut-off value of TAPSE/PASP to determine in-hospital mortality was 0.49. Among others, univariable associates of impaired TAPSE/PASP were the Global Registry of Acute Coronary event (GRACE) risk score, Killip Class &amp;gt;2, late presentation after symptoms onset, NT-pro-BNP, and left ventricular ejection fraction (LVEF). In multivariable analysis LVEF was the only independent predictor of impaired TAPSE/PASP (OR 0.889, 95% CI [0.821-0.963], p=0.004). The subgroup of patients with LVEF&amp;lt;40% and TAPSE/PASP&amp;lt;0.49mm/mmHg exhibited the worst in-hospital mortality rate (Abstract Picture 1). TAPSE/PASP was significantly associated with in-hospital mortality (OR 0.037, 95% CI [0.009-0.153], p&amp;lt;0.001), and retained this association after adjusting for GRACE risk score and LVEF (OR 0.137, 95% CI [0.032-0.578], p=0.007). The incremental prognostic value of TAPSE/PASP&amp;lt;0.49mm/mmHg for in-hospital mortality was evaluated by adding it to a model including the GRACE risk-score, LVEF&amp;lt;40% and TAPSE&amp;lt;17mm. The further addition of impaired TAPSE/PASP significantly increased the x² of the model from 21.627 to 86.213, p&amp;lt;0.001 (Abstract Picture 2). Conclusion RV-PA coupling assessed non-invasively by echocardiography 24 hours after revascularization was an independent predictor of in-hospital mortality in patients with first ACS and may improve risk stratification.In hospital mortality ratesIncremental prognostic value

The importance of evaluation for living alone among acute myocardial infarction patients

Abstract Background Assessment of the mortality risk in acute myocardial infarction (AMI) patients is crucial when making medical decisions because AMI is an important public health issue and a major cause of death worldwide. The Global Registry of Acute Coronary Events (GRACE) risk score is useful for estimating in-hospital mortality at the time of admission and is in wide use. On the other hand, in the rapidly aging societies of the modern era, social isolation and absence of support are important welfare issues. Among them, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. Purpose The purpose of this study was to investigate the association between living alone and cardiac deaths in AMI patients after percutaneous coronary intervention (PCI), and to determine whether this association was independent of GRACE risk score as a score that is widely used in clinical settings. Methods This study was a retrospective cohort study, investigating 277 consecutive AMI patients who underwent successful revascularization of the culprit lesion by primary PCI. Associations between cardiac deaths after PCI and baseline characteristics including living alone and GRACE risk score were assessed. Furthermore, this study also assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI). Results Median duration of follow-up was 1153 days (IQR, 560–1566 days). In this population, median age was 69 years (IQR, 59–77 years), and 198 patients (71%) were male. Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of cardiac deaths compared with patients not living alone (14% vs. 4%, p=0.004). The proportion of males differed significantly between living alone and not living alone groups (p=0.004). GNRI was significantly lower in the living alone group than in the not living alone group (p&amp;lt;0.001 and p=0.048). GRACE risk score was significantly higher in the living alone group (median, 140; IQR, 107–170) than in the not living alone group (median, 127; IQR, 103–149; p=0.038). Multivariate Cox proportional hazards regression analysis models showed living alone (hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.60–10.84; p=0.003), GNRI (HR, 0.94; 95%CI, 0.91-0.98; p=0.003), and GRACE risk score (HR, 1.03; 95%CI, 1.01-1.04; p&amp;lt;0.001) were significantly associated with cardiac death after PCI. A comparison of p values for the interaction of GRACE risk score and either living alone and GNRI were p=0.082 and p=0.244, respectively. Conclusions The current study revealed that living alone represents an independent risk factor for cardiac deaths in AMI patients after PCI, separate from GRACE risk score. Evaluation of living arrangements may provide more information regarding prognosis for AMI patients.

Circulating dipeptidyl peptidase 3 predicts hemodynamic impairment and premature death in acute coronary syndromes: insights from the prospective multicenter SPUM-ACS study

Abstract Background Dipeptidyl peptidase 3 (DPP3) is mechanistically involved in the degradation of angiotensin II and in the depression of systolic left ventricular function thereby disturbing peripheral blood pressure regulation. Small pilot studies suggested that circulating DPP3 (cDPP3) portends poor outcomes in acute heart failure and may refine risk assessment in patients with acute coronary syndromes (ACS). Purpose We aimed to assess the predictive value of cDPP3 in contemporary patients with ACS. Methods Circulating DPP3 was studied in 4311 patients with ACS in the prospective multicentre SPUM-ACS study. DPP3 levels were centrally measured in EDTA plasma by blinded study personnel using an established sandwich-type luminometric immunoassay. Kaplan-Meier survival curves and multivariable-adjusted regression models adjusted for sex, age, heart rate, systolic blood pressure, history of diabetes, levels of creatinine, centrally measured high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein, and the Global Registry of Acute Coronary Events (GRACE) risk score. Results At baseline, median cDPP3 levels were 19.0 ng/ml (interquartile range [IQR] 15.0-26.0) with higher levels observed in patients with ST-segment elevation myocardial infarction than in those with non-ST-segment elevation ACS (20.1 [15.9-28.2] vs. 18.0 [14.1-23.9], respectively, P&amp;lt;0.001). High cDPP3 was linked to longer hospitalization and higher risk to require vasopressor use or mechanical circulatory support (per log2 increase: odds ratio [OR] 1.91, 95% confidence interval [CI] 1.62-2.24, P&amp;lt;0.001; adjusted OR 1.35 95% CI 1.08-1.69, P=0.008). In line, high cDPP was strongly associated with increased mortality at 30 days (per log2 increase: hazard ratio [HR] 1.96, 95% CI 1.48-2.59, P&amp;lt;0.001) and at 1 year (HR 1.51, 95% CI 1.24-1.83, P&amp;lt;0.001). When accounting for established risk factors, cDPP3 remained an independent predictor of premature death with doubling in cDPP3 levels translating into an 58% and 40% increase in 30-day and 1-year mortality risk, respectively (adjusted HR 1.58, 95% CI 1.06-2.34, P&amp;lt;0.023, adjusted HR 1.40, 95% CI 1.10-1.77, P=0.006, respectively). Conclusion We identified cDPP3 as a novel marker of cardiogenic shock and increased mortality in patients with ACS. Circulating DPP3 provides prognostic information beyond established risk factors and improves early risk assessment.DPP3 is linked to hemodynamic impairmentDPP3 independently predicts mortality

Prognostic Value of GRACE Risk Score Combined With Systemic Immune-Inflammation Index in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention

The Global Registry of Acute Coronary Events (GRACE) score and the systemic immune-inflammation index (SII) were used independently to predict adverse outcomes in patients with ST-elevation myocardial infarction (STEMI). In this study, 1041 patients with STEMI were divided into 4 groups based on GRACE scores and optimal cutoff values for SII. SII was positively correlated with GRACE score (r = 0.164; P &lt; .001). SII (HR, hazard ratio: 2.051; 95%CI: 1.249–3.368; P = .005) and GRACE score (HR: 7.625; 95%CI: 3.692–15.746; P &lt; .001) were independent risk predictors of short-term major adverse cardiovascular events (MACEs). Taking the low SII+low GRACE group as the reference group, the short-term MACE HR of the high SII+high GRACE group was 40.470 (95%CI: 5.547–295.253). Comparing the area under the curve, the combined use of SII and GRACE scores can significantly improve the prediction efficiency of short-term MACE compared with the single use of SII and GRACE scores. In conclusion, SII may be positively correlated with GRACE score, and the combination of the two accurately predicted the occurrence of short-term MACE in STEMI patients after percutaneous coronary intervention (PCI).