Adjustment of the GRACE score by growth differentiation factor 15 enables a more accurate appreciation of risk in non-ST-elevation acute coronary syndrome

Abstract Background The aim of this study was to determine the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for predicting in-hospital and 6 months mortality after non-ST elevation acute coronary syndrome (NSTE-ACS). Results In this observational study, 300 patients with NSTE-ACS of age more than 30 years were included; 16 patients died during the hospital stay (5.3%). Of 284 patients at 6 months assessment, 10 patients died (3.5%), 240 survived (84.5%), and 34 were lost to follow-up (12%) respectively. In high risk category, 10.5% of the patients died within hospital stay and 11.8% died within 6 months (p = 0.001 and p = 0.013). In univariate analysis, gender, diabetes mellitus, family history, smoking, and GRACE score were significantly associated with in-hospital mortality whereas age, obesity, dyslipidemia, and GRACE were significantly associated with 6 months mortality. After adjustment, diabetes mellitus, family history, and GRACE score remained significantly associated with in-hospital mortality (p ≤ 0.05) and age remained significantly associated with 6 months mortality. Conclusion GRACE risk score has good predictive value for the prediction of in-hospital mortality and 6 months mortality among patients with NSTE-ACS.

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PROGNOSTIC VALUE OF GRACE VERSUS TIMI SCORE FOR IN-HOSPITAL OUTCOMES AFTER NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Pakistan Heart Journal ◽

10.47144/phj.v54i4.2081 ◽

2022 ◽

Vol 54 (4) ◽

pp. 361-366

Author(s):

Dileep Kumar ◽

Tahir Saghir ◽

Kamran Ahmed Khan ◽

Khalid Naseeb ◽

Gulzar Ali ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Predictive Value ◽

Clinical Decision Making ◽

Hospital Outcomes ◽

Coronary Syndrome ◽

Timi Score ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Grace Score

Objectives: To compare the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). Methodology: This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center of Karachi, Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores. Results: A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04±10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19±33.17 and 3.18±0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cut-off value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cut-off value of 4 with sensitivity of 75.0% and specificity of 67.6%. Conclusion: The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.

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Growth-Differentiation Factor-15 for Long-Term Risk Prediction in Patients Stabilized After an Episode of Non–ST-Segment–Elevation Acute Coronary Syndrome

Circulation Cardiovascular Genetics ◽

10.1161/circgenetics.109.877456 ◽

2010 ◽

Vol 3 (1) ◽

pp. 88-96 ◽

Cited By ~ 69

Author(s):

Kai M. Eggers ◽

Tibor Kempf ◽

Bo Lagerqvist ◽

Bertil Lindahl ◽

Sylvia Olofsson ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Prediction ◽

Growth Differentiation Factor 15 ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Differentiation Factor ◽

St Segment ◽

Elevation Acute Coronary Syndrome

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OP-079 The Role of GRACE Score in Prediction of High Risk Coronary Anatomy in Patients with Non-ST Elevation Acute Coronary Syndrome

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.01.125 ◽

2015 ◽

Vol 115 ◽

pp. S35

Author(s):

Burcak Kilickiran Avci ◽

Baris Ikitimur ◽

Ozge Ozden Tok ◽

Murat Cimci ◽

Emre Erturk ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Coronary Anatomy ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Grace Score

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Change in Growth Differentiation Factor 15, but Not C-Reactive Protein, Independently Predicts Major Cardiac Events in Patients with Non-ST Elevation Acute Coronary Syndrome

Mediators of Inflammation ◽

10.1155/2014/929536 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Alberto Dominguez-Rodriguez ◽

Pedro Abreu-Gonzalez ◽

Idaira F. Hernandez-Baldomero ◽

Pablo Avanzas ◽

Francisco Bosa-Ojeda

Keyword(s):

Acute Coronary Syndrome ◽

Rate Of Change ◽

C Reactive Protein ◽

Cardiac Events ◽

Growth Differentiation Factor 15 ◽

St Segment Elevation ◽

Reactive Protein ◽

Coronary Syndrome ◽

Differentiation Factor ◽

Elevation Acute Coronary Syndrome

Among the numerous emerging biomarkers, high-sensitivity C-reactive protein (hsCRP) and growth-differentiation factor-15 (GDF-15) have received widespread interest, with their potential role as predictors of cardiovascular risk. The concentrations of inflammatory biomarkers, however, are influenced, among others, by physiological variations, which are the natural, within-individual variation occurring over time. The aims of our study are: (a) to describe the changes in hsCRP and GDF-15 levels over a period of time and after an episode of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and (b) to examine whether the rate of change in hsCRP and GDF-15 after the acute event is associated with long-term major cardiovascular adverse events (MACE). Two hundred and Fifty five NSTE-ACS patients were included in the study. We measured hsCRP and GDF-15 concentrations, at admission and again 36 months after admission (end of the follow-up period). The present study shows that the change of hsCRP levels, measured after 36 months, does not predict MACE in NSTEACS-patients. However, the level of GDF-15 measured, after 36 months, was a stronger predictor of MACE, in comparison to the acute unstable phase.

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