Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Cardiovascular Division, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA.
Clin Interv Aging. 2018 Jun 6;13:1099-1109. doi: 10.2147/CIA.S166100. eCollection 2018.
New-onset atrial fibrillation (NOAF) is a common finding in patients with myocardial infarction (MI), but few studies are available regarding the prediction model for its risk estimation. Although Global Registry of Acute Coronary Events (GRACE) risk score (RS) has been recognized as an effective tool for the risk evaluation of clinical outcomes in patients with MI, its usefulness in the prediction of post-MI NOAF remains unclear. In this study, we sought to validate the discrimination performance of GRACE RS in the prediction of post-MI NOAF and to make a comparison with that of the CHADS-VASc score in patients with ST-segment elevation myocardial infarction (STEMI).
A total of 488 patients with STEMI who were admitted to our hospital between May 2015 and October 2016 without a history of atrial fibrillation were retrospectively evaluated in this study. GRACE and CHADS-VASc scores were calculated for each patient. Patients were divided into low (GRACE RS≤125)-, intermediate (GRACE RS 126-154)-, and high (GRACE RS≥155)-risk groups. Receiver operating characteristic curve analyses were performed to evaluate the discrimination performance of both RSs. Model calibration was evaluated by using Hosmer-Lemeshow goodness-of-fit test (HLS).
Of the 488 eligible patients, 49 (10.0%) developed NOAF during hospitalization. In the overall cohort, the discrimination performance of GRACE RS (C-statistic: 0.76, 95% CI: 0.72-0.80) was significantly better than that of CHADS-VASc score (C-statistic: 0.68, 95% CI: 0.64-0.72; comparison =0.03). For subgroup analysis, GRACE RS tended to be better than the CHADS-VASc score in all but the intermediate-risk group as evidenced by C-statistics of 0.60 and 0.65 for GRACE and CHADS-VASc scores, respectively. Excellent calibration was achieved except for GRACE RS in females (HLS =0.05).
The diagnostic performance of GRACE RS is relatively high as well as better than that of the CHADS-VASc score with respect to the prediction of post-MI NOAF.
新发心房颤动（NOAF）是心肌梗死（MI）患者的常见发现，但关于其风险评估的预测模型的研究较少。尽管全球急性冠状动脉事件注册（GRACE）风险评分（RS）已被公认为评估 MI 患者临床结局风险的有效工具，但它在预测 MI 后 NOAF 中的作用尚不清楚。在这项研究中，我们旨在验证 GRACE RS 在预测 MI 后 NOAF 中的区分性能，并与 ST 段抬高型心肌梗死（STEMI）患者的 CHADS-VASc 评分进行比较。
本研究回顾性分析了 2015 年 5 月至 2016 年 10 月期间我院收治的 488 例无房颤病史的 STEMI 患者。为每位患者计算 GRACE 和 CHADS-VASc 评分。患者被分为低（GRACE RS≤125）、中（GRACE RS 126-154）和高（GRACE RS≥155）风险组。通过受试者工作特征曲线分析评估两种 RS 的区分性能。通过 Hosmer-Lemeshow 拟合优度检验（HLS）评估模型校准。
在 488 例合格患者中，49 例（10.0%）在住院期间发生 NOAF。在整个队列中，GRACE RS（C 统计量：0.76，95%CI：0.72-0.80）的区分性能明显优于 CHADS-VASc 评分（C 统计量：0.68，95%CI：0.64-0.72；比较=0.03）。对于亚组分析，GRACE RS 在除中危组以外的所有组中的表现均优于 CHADS-VASc 评分，GRACE 和 CHADS-VASc 评分的 C 统计量分别为 0.60 和 0.65。除了女性的 GRACE RS（HLS=0.05）外，其余均达到了优秀的校准。
GRACE RS 在预测 MI 后 NOAF 方面的诊断性能较高，优于 CHADS-VASc 评分。
