Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome

Frontiers in Cardiovascular Medicine

article

Shoupeng Duan¹  Jun Wang¹  Fu Yu¹  Lingpeng Song¹  Chengzhe Liu¹  Ji Sun¹  Qiang Deng¹  Yijun Wang¹  Zhen Zhou¹  Fuding Guo¹  Liping Zhou¹  Yueyi Wang¹  Wuping Tan¹  Hong Jiang¹  Lilei Yu¹ 

[1] Department of Cardiology, Renmin Hospital of Wuhan University;Cardiac Autonomic Nervous System Research Centre of Wuhan University;Cardiovascular Research Institute, Wuhan University;Hubei Key Laboratory of Cardiology

关键词: acute coronary syndrome;    GRACE score;    deceleration capacity;    autonomic nerve;    long-term prognosis;   

DOI  :  10.3389/fcvm.2022.888753

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Cardiac autonomic nerve imbalance has been well documented to provide a critical foundation for the development of acute coronary syndrome (ACS) but is not included in the postdischarge GRACE score. We investigated whether capturing cardiac autonomic nervous system (ANS)-related modulations by 24-h deceleration capacity (DC) could improve the capability of existing prognostic models, including the postdischarge Global Registry of Acute Coronary Events (GRACE) score, to predict prognosis after ACS. Method Patients with ACS were assessed with 24-h Holter monitoring in our department from June 2017 through June 2019. The GRACE score was calculated for postdischarge 6-month mortality. The patients were followed longitudinally for the incidence of major adverse cardiac events (MACEs), set as a composite of non-fatal myocardial infarction and death. To evaluate the improvement in its discriminative and reclassification capabilities, the GRACE score with DC model was compared with a model using the GRACE score only, using area under the receiver-operator characteristic curve (AUC), Akaike's information criteria, the likelihood ratio test, category-free integrated discrimination index (IDI) and continuous net reclassification improvement (NRI). Results Overall, 323 patients were enrolled consecutively. After the follow-up period (mean, 43.78 months), 41 patients were found to have developed MACEs, which were more frequent among patients with DC 0 7.3%, NRIne >0 12.8%, NRI >0 0.200; p = 0.003). Entering the DC into the GRACE score model enhanced discrimination (IDI of 1.04%, p < 0.001). Conclusion DC serves as an independent and effective predictor of long-term adverse outcomes after ACS. Integration of DC and the postdischarge GRACE score significantly enhanced the discriminatory capability and precision in the prediction of poor long-term follow-up prognosis.

【 授权许可】

CC BY