McAllister David A, Halbesma Nynke, Carruthers Kathryn, Denvir Martin, Fox Keith A
Centre for Population Health Sciences, University of Edinburgh, UK
Centre for Population Health Sciences, University of Edinburgh, UK.
Eur Heart J Acute Cardiovasc Care. 2015 Apr;4(2):165-71. doi: 10.1177/2048872614542724. Epub 2014 Jul 1.
Congestive heart failure (CHF) is a common and preventable complication of acute coronary syndrome (ACS). Nevertheless, ACS risk scores have not been shown to predict CHF risk. We investigated whether the at-discharge Global Registry of Acute Coronary Events (GRACE) score predicts heart failure admission following ACS.
Five-year mortality and hospitalization data were obtained for patients admitted with ACS from June 1999 to September 2009 to a single centre of the GRACE registry. CHF was defined as any admission assigned WHO International Classification of Diseases 10 diagnostic code I50. The hazard ratio (HR) for CHF according to GRACE score was estimated in Cox models adjusting for age, gender and the presence of CHF on index admission. Among 1,956 patients, CHF was recorded on index admission in 141 patients (7%), and 243 (12%) were admitted with CHF over 3.8 median years of follow-up. Compared to the lowest quintile, patients in the highest GRACE score quintile had more CHF admissions (116 vs 17) and a shorter time to first admission (1.2 vs 2.0 years, HR 9.87, 95% CI 5.93-16.43). Per standard deviation increment in GRACE score, the instantaneous risk was more than two-fold higher (HR 2.28; 95% CI 2.02-2.57), including after adjustment for CHF on index admission, age and gender (HR 2.49; 95% CI 2.06-3.02). The C-statistic for CHF admission at 1-year was 0.74 (95% CI 0.70-0.79).
The GRACE score predicts CHF admission, and may therefore be used to target ACS patients at high risk of CHF with clinical monitoring and therapies.
充血性心力衰竭（CHF）是急性冠状动脉综合征（ACS）常见且可预防的并发症。然而，ACS风险评分尚未显示出能预测CHF风险。我们研究了出院时的全球急性冠状动脉事件注册研究（GRACE）评分是否能预测ACS后心力衰竭的入院情况。
获取了1999年6月至2009年9月在GRACE注册研究的单个中心因ACS入院患者的5年死亡率和住院数据。CHF被定义为任何被指定为世界卫生组织国际疾病分类第10版诊断代码I50的入院情况。在Cox模型中，根据GRACE评分估计CHF的风险比（HR），并对年龄、性别和首次入院时是否存在CHF进行校正。在1956例患者中，141例（7%）在首次入院时记录有CHF，在3.8年的中位随访期内，243例（12%）因CHF入院。与最低五分位数相比，GRACE评分最高五分位数的患者CHF入院次数更多（116次对17次），首次入院时间更短（1.2年对2.0年，HR 9.87，95%CI 5.93 - 16.43）。GRACE评分每增加一个标准差，即时风险高出两倍多（HR 2.28；95%CI 2.02 - 作 者 简况 2.57），包括在对首次入院时的CHF、年龄和性别进行校正后（HR 2.49；95%CI 2.06 - 3.02）。1年时CHF入院的C统计量为0.74（95%CI 0.70 - 0.79）。
GRACE评分可预测CHF入院情况，因此可用于针对有CHF高风险的ACS患者进行临床监测和治疗。
