scholarly journals Prognostic impact of alkaline phosphatase for in-hospital mortality in patients with acute coronary syndrome: a prospective cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025648
Author(s):  
Tongtong Yu ◽  
Yundi Jiao ◽  
Jia Song ◽  
Dongxu He ◽  
Jiake Wu ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Continuous Variable ◽  
Prognostic Performance ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Grace Score ◽  
Multivariable Adjustment

ObjectivesAlkaline phosphatase (ALP) can promote vascular calcification, but the association between ALP and in-hospital mortality in patients with acute coronary syndrome (ACS) is not well defined.DesignA prospective cohort study.Setting and participantsA total of 6368 patients with ACS undergoing percutaneous coronary intervention (PCI) from 1 January 2010 to 31 December 2017 were analysed.Main outcome measuresIn-hospital mortality was used in this study.ResultsALP was analysed both as a continuous variable and according to three categories. After multivariable adjustment, in-hospital mortality was significantly higher in Tertile 3 group (ALP＞85 U/L) (OR: 2.399, 95% CI 1.080 to 5.333, p=0.032), compared with other two groups (Tertile 1: ＜66 U/L; Tertile 2: 66–85 U/L). When ALP was evaluated as a continuous variable, after multivariable adjustment, the ALP level was associated with an increased risk of in-hospital mortality (OR: 1.011, 95% CI 1.002 to 1.020, p=0.014). C-statistic of ALP for predicting in-hospital mortality was 0.630 (95% CI 0.618 to 0.642, p=0.001). The cut-off value was 72 U/L with a sensitivity of 0.764 and a specificity of 0.468. However, ALP could not significantly improve the prognostic performance of Global Registry of Acute Coronary Events (GRACE) score (GRACE score+ALP vs GRACE score: C-statistic: z=0.485, p=0.628; integrated discrimination improvement: 0.014, p=0.056; net reclassification improvement: 0.020, p=0.630).ConclusionsIn patients with ACS undergoing PCI, ALP was an independent predictor of in-hospital mortality. But it could not improve the prognostic performance of GRACE score.

scholarly journals Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tongtong Yu ◽  
Yundi Jiao ◽  
Jia Song ◽  
Dongxu He ◽  
Jiake Wu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Added Value ◽  
Hospital Death ◽  
Prognostic Performance ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Grace Score ◽  
D Dimer

Abstract Backgroud To assess the value of D-dimer and its combination with The Global Registry of Acute Coronary Events (GRACE) score in predicting in-hospital mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods In 5923 ACS patients undergoing PCI, the role of D-dimer and the added value of D-dimer to GRACE score for predicting in-hospital mortality were tested. Results After multivariable adjustment, D-dimer could significantly predict in-hospital mortality. Also, it could significantly improve the prognostic performance of GRACE score (C-statistic: z = 2.269, p = 0.023; IDI: 0.016, p = 0.032; NRI: 0.291, p = 0.035). Conclusion In patients with ACS undergoing PCI, D-dimer was an independent predictor of in-hospital death. It could also improve the prognostic performance of GRACE score.

scholarly journals Prognostic impact of albumin-bilirubin score on the prediction of in-hospital mortality in patients with heart failure: a retrospective cohort study

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e049325
Author(s):  
Su Han ◽  
Chuanhe Wang ◽  
Fei Tong ◽  
Ying Li ◽  
Zhichao Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Continuous Variable ◽  
Hospital Death ◽  
Prognostic Impact ◽  
C Statistic ◽  
Patients With Heart Failure

ObjectivesLiver dysfunction is prevalent in patients with heart failure (HF) and can lead to poor prognosis. The albumin-bilirubin (ALBI) score is considered as an effective and convenient scoring system for assessing liver function. We analysed the correlation between ALBI and in-hospital mortality in patients with HF.DesignA retrospective cohort study.Setting and participantsA total of 9749 patients with HF (from January 2013 to December 2018) was enrolled and retrospectively analysed.Main outcome measuresThe main outcome is in-hospital mortality.ResultsALBI score was calculated using the formula (log10 bilirubin [umol/L] * 0.66) + (albumin [g/L] * −0.085), and analysed as a continuous variable as well as according to three categories. Following adjustment for multivariate analysis, patients which occurred in-hospital death was remarkably elevated in tertile 3 group (ALBI ≥2.27) (OR 1.671, 95% CI 1.228 to 2.274, p=0.001), relative to the other two groups (tertile 1: ≤2.59; tertile 2: −2.59 to −2.27). Considering ALBI score as a continuous variable, the in-hospital mortality among patients with HF increased by 8.2% for every 0.1-point increase in ALBI score (OR 1.082; 95% CI 1.052 to 1.114; p<0.001). The ALBI score for predicting in-hospital mortality under C-statistic was 0.650 (95% CI 0.641 to 0.660, p<0.001) and the cut-off value of ALBI score was −2.32 with a specificity of 0.630 and a sensitivity of 0.632. Moreover, ALBI score can enhance the predictive potential of NT-pro-BNP (NT-pro-BNP +ALBI vs NT-pro-BNP: C-statistic: z=1.990, p=0.0467; net reclassification improvement=0.4012, p<0.001; integrated discrimination improvement=0.0082, p<0.001).ConclusionsIn patients with HF, the ALBI score was an independent prognosticator of in-hospital mortality. The predictive significance of NT-proBNP +ALBI score was superior to NT-proBNP, and ALBI score can enhance the predictive potential of NT-proBNP.

scholarly journals Prognostic value of GRACE score for in-hospital and 6 months outcomes after non-ST elevation acute coronary syndrome

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Dileep Kumar ◽  
Arti Ashok ◽  
Tahir Saghir ◽  
Naveedullah Khan ◽  
Bashir Ahmed Solangi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Family History ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Predictive Value ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Grace Score

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.

scholarly journals Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Centola ◽  
A Maloberti ◽  
S Persampieri ◽  
D Castini ◽  
N Morici ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Prognostic Value ◽  
Risk Model ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Incremental Prognostic Value ◽  
Grace Score

Abstract Background Hyperuricemia has been associated with high mortality rates in patients with acute myocardial infarction. The role and the prognostic relevance of increased serum uric acid (SUA) in patients with acute coronary syndrome (ACS) are still under debate Aim We sought to assess the association between elevated admission levels of SUA and in-hospital adverse outcomes in a real-world patient population with ACS and to investigate the potential incremental prognostic value of SUA added to GRACE score Methods 1088 consecutive patients admitted with a diagnosis of ACS to the Coronary Care Unit of two Hospitals were enrolled. Medical history, clinical characteristic, biochemical and electrocardiographic findings, angiographic data, treatments administered during hospitalization were all collected on an electronic database. All patients' data were entered prospectively in the database of the two hospitals and retrospectively analysed. Results The mean age was 68 years (IQR 60–78). Less than one-third of the total population was female (24%). Diabetes mellitus was present in 308 (28%) patients. The proportion of patients with STEMI and NSTEMI/UA was quite similar: 504 (46%) patients had a diagnosis of STEMI and 584 (54%) patients had a diagnosis of NSTEMI/UA. The GRACE score was 133 (IQR 112–156). In-hospital mortality rate was 2.3% in the overall population. Two variables were associated with a significantly increased risk of in-hospital death at the multivariate analysis: SUA (OR 1.72 95% CI 1.33–2.22, p&lt;0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p&lt;0.0001). To investigate the potential incremental prognostic value of SUA added to GRACE score for in-hospital death, we analyzed the results of adding hyperuricemia as categorical variable to the original GRACE risk model (GRACE-SUA score). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89–0.93, p&lt;0.0001) and 0.79 (95% CI 0.76–0.81, p&lt;0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93–0.95; p&lt;0.0001). The addition of hyperuricemia to the GRACE score led to reclassifying 18 of 211 (8.5%) patients without in-hospital deaths from high to low risk. No patients with o without events were incorrectly reclassified. The net-reclassification index (NRI) of the GRACE-SUA score was 1.7% (z value of 4.3; p&lt;0.001). Conclusions High admission levels of SUA are positively and independently associated with in-hospital adverse outcomes and mortality in a contemporary and unselected population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality and to improve risk classification in this study population. Funding Acknowledgement Type of funding source: None

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

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.

scholarly journals Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain

2018 ◽  
Vol 12 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Taysir S Garadah ◽  
Khalid Bin Thani ◽  
Leena Sulibech ◽  
Ahmed A Jaradat ◽  
Mohamed E Al Alawi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Systolic Hypertension ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Positive Serum ◽  
Grace Score

Background: Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before. Aim: In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission. Methods: Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG. Results: Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation. Conclusion: Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.

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

2018 ◽  
Vol 33 (2) ◽  
pp. 94-99
Author(s):  
Md Mesbahul Islam ◽  
Mohsin Ahmed ◽  
Mohammad Ali ◽  
Abdul Wadud Chowdhury ◽  
Khandakar Abu Rubayat
Keyword(s):  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Hospital Mortality ◽  
Blood Sugar ◽  
Risk Score ◽  
Hospital Death ◽  
Predictive Values ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
Grace Score

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

P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Martin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Elderly Patients ◽  
Predictive Performance ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
C Statistic ◽  
The Impact ◽  
Grace Score

Abstract Background The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss. Purpose The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores. Methods The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores. Results We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table) C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value. Conclusions This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.

Prognostic Implications of Dual Platelet Reactivity Testing in Acute Coronary Syndrome

2018 ◽  
Vol 118 (02) ◽  
pp. 415-426 ◽  
Author(s):  
Leonardo de Carvalho ◽  
Alan Fong ◽  
Richard Troughton ◽  
Bryan Yan ◽  
Chee-Tang Chin ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Adenosine Diphosphate ◽  
Coronary Intervention ◽  
Initial Test ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Coronary Events ◽  
Few Data ◽  
Grace Score

AbstractStudies on platelet reactivity (PR) testing commonly test PR only after percutaneous coronary intervention (PCI) has been performed. There are few data on pre- and post-PCI testing. Data on simultaneous testing of aspirin and adenosine diphosphate antagonist response are conflicting. We investigated the prognostic value of combined serial assessments of high on-aspirin PR (HASPR) and high on-adenosine diphosphate receptor antagonist PR (HADPR) in patients with acute coronary syndrome (ACS). HASPR and HADPR were assessed in 928 ACS patients before (initial test) and 24 hours after (final test) coronary angiography, with or without revascularization. Patients with HASPR on the initial test, compared with those without, had significantly higher intraprocedural thrombotic events (IPTE) (8.6 vs. 1.2%, p ≤ 0.001) and higher 30-day major adverse cardiovascular and cerebrovascular events (MACCE; 5.2 vs. 2.3%, p = 0.05), but not 12-month MACCE (13.0 vs. 15.1%, p = 0.50). Patients with initial HADPR, compared with those without, had significantly higher IPTE (4.4 vs. 0.9%, p = 0.004), but not 30-day (3.5 vs. 2.3%, p = 0.32) or 12-month MACCE (14.0 vs. 12.5%, p = 0.54). The c-statistic of the Global Registry of Acute Coronary Events (GRACE) score alone, GRACE score + ASPR test and GRACE score + ADPR test for discriminating 30-day MACCE was 0.649, 0.803 and 0.757, respectively. Final ADPR was associated with 30-day MACCE among patients with intermediate-to-high GRACE score (adjusted odds ratio [OR]: 4.50, 95% confidence interval [CI]: 1.14–17.66), but not low GRACE score (adjusted OR: 1.19, 95% CI: 0.13–10.79). In conclusion, both HASPR and HADPR predict ischaemic events in ACS. This predictive utility is time-dependent and risk-dependent.

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