Khan Sohail Q, Narayan Hafid, Ng Kelvin H, Dhillon Onkar S, Kelly Dominic, Quinn Paulene, Squire Iain B, Davies Joan E, Ng Leong L
Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
Clin Sci (Lond). 2009 Jun 2;117(1):31-9. doi: 10.1042/CS20080419.
The GRACE (Global Registry of Acute Coronary Events) risk score has been shown to offer predictive power with regard to death and AMI (acute myocardial infarction) in patients with ACS (acute coronary syndromes). NT-proBNP (N-terminal pro-B-type natriuretic peptide) has also been found to be useful in predicting mortality following ACS. In the present study, we sought to investigate the use of the GRACE score and NT-proBNP levels at predicting risk of early and late deaths following ACS. We studied 1033 patients (740 men, mean age 66.5+/-12.7 years) with AMI. Blood was drawn once within 24 h following the onset of chest pain. The plasma concentration of NT-proBNP was determined using an in-house non-competitive immunoassay. Patients were GRACE risk scored. The 30-day mortality was 3.7% and the 6-month mortality was 7.8%, and all were related to higher GRACE risk scores (P=0.001 for trend). Higher NT-proBNP levels were also related to increased mortality (P<0.0001). In a Cox proportional hazards model, independent predictors of 30-day and 6-month mortality included NT-proBNP levels and the GRACE risk score. The receiver-operating curve for the GRACE risk score was complemented by NT-proBNP levels for prediction of 30-day mortality [AUC (area under the curve), 0.85] and 6-month mortality (AUC, 0.81). NT-proBNP gives complementary information to the GRACE risk score for predicting early and late mortality. The inclusion of the NT-proBNP blood test is useful in risk-stratifying patients after ACS.
全球急性冠状动脉事件注册研究（GRACE）风险评分已被证明对急性冠状动脉综合征（ACS）患者的死亡和急性心肌梗死（AMI）具有预测能力。N末端B型脑钠肽原（NT-proBNP）也被发现有助于预测ACS后的死亡率。在本研究中，我们试图探讨GRACE评分和NT-proBNP水平在预测ACS后早期和晚期死亡风险方面的应用。我们研究了1033例AMI患者（740例男性，平均年龄66.5±12.7岁）。在胸痛发作后24小时内采集一次血液。采用内部非竞争性免疫测定法测定血浆NT-proBNP浓度。对患者进行GRACE风险评分。30天死亡率为3.7%，6个月死亡率为7.8%，且均与较高的GRACE风险评分相关（趋势P=0.001）。较高的NT-proBNP水平也与死亡率增加相关（P<0.0001）。在Cox比例风险模型中，30天和6个月死亡率的独立预测因素包括NT-proBNP水平和GRACE风险评分。GRACE风险评分的受试者工作特征曲线通过NT-proBNP水平得到补充，用于预测30天死亡率（曲线下面积[AUC]，0.85）和6个月死亡率（AUC，0.81）。NT-proBNP为GRACE风险评分提供补充信息，以预测早期和晚期死亡率。纳入NT-proBNP血液检测有助于对ACS后的患者进行风险分层。
