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 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 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<0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p<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<0.0001) and 0.79 (95% CI 0.76–0.81, p<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<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<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 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

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.

scholarly journals Echocardiographic Parameters as Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Miroslava Sladojevic ◽  
Srdjan Sladojevic ◽  
Dubravko Culibrk ◽  
Snezana Tadic ◽  
Robert Jung
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Right Ventricle ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Echocardiographic Parameters

Different ways have been used to stratify risk in acute coronary syndrome (ACS) patients. The aim of the study was to examine the usefulness of echocardiographic parameters as predictors of in-hospital outcome in patients with ACS after percutaneous coronary intervention (PCI). A data of 2030 patients with diagnosis of ACS hospitalized from December 2008 to December 2011 was used to develop a risk model based on echocardiographic parameters using the binary logistic regression. This model was independently evaluated in validation cohort prospectively (954 patients admitted during 2012). In-hospital mortality in derivation cohort was 7.73%, and 6.28% in validation cohort. Developed model has been designed with 4 independent echocardiographic predictors of in-hospital mortality: left ventricular ejection fraction (LVEF RR=0.892; 95%CI=0.854–0.932,P<0.0005), aortic leaflet separation diameter (AOvs RR=0.131; 95%CI=0.027–0.627,P=0.011), right ventricle diameter (RV RR=2.675; 95%CI=1.109–6.448,P=0.028) and right ventricle systolic pressure (RVSP RR=1.036; 95%CI=1.000–1.074,P=0.048). Model has good prognostic accuracy (AUROC=0.84) and it retains good (AUROC=0.78) when testing on the validation cohort. Risks for in-hospital mortality after PCI in ACS patients using echocardiographic measurements could be accurately predicted in contemporary practice. Incorporation of such developed model should facilitate research, clinical decisions, and optimizing treatment strategy in selected high risk ACS patients.

Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention

Kardiologiia ◽  
2020 ◽  
Vol 60 (9) ◽  
pp. 38-45
Author(s):  
M. V. Zykov ◽  
N. V. D’yachenko ◽  
O. A. Trubnikova ◽  
A. D. Erlih ◽  
V. V. Kashtalap ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Fold Increase ◽  
Female Gender ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Emergency Percutaneous Coronary Intervention

Aim        To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods        The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results   Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion            This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification. 

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