Yin Guoqing, Abdu Fuad A, Liu Lu, Xu Siling, Xu Bin, Luo Yanru, Lv Xian, Fan Rui, Che Wenliang
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiology, Clinical Medical College of Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.
Front Cardiovasc Med. 2021 Feb 16;8:582246. doi: 10.3389/fcvm.2021.582246. eCollection 2021.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a special type of myocardial infarction (MI). The GRACE risk score is commonly used to predict major adverse cardiovascular events (MACE) in non-ST-elevation myocardial infarction patients, and the suitability of the GRACE risk score for prognostic stratification in patients with MINOCA remains uncertain. This study aimed to investigate whether the GRACE risk score is capable of predicting MACE in MINOCA patients with NSTE. We calculated the GRACE risk score for 340 consecutive MINOCA patients with NSTE. Patients were divided into a low-intermediate risk group (≤ 140, 48.8%) and a high risk group (>140, 51.2%) according to their GRACE risk scores. The clinical characteristics and outcomes of the patients were assessed. Patients in the high risk group tended to be older and to have more comorbidities. At the 1-year follow-up, the rate of cardiac death in the high risk group was significantly higher than that in the low-intermediate-risk group ( = 0.010). There was no significant difference in non-fatal MI, stroke, heart failure, or cardiovascular-related rehospitalization. The incidence of total MACE was significantly higher in patients with high GRACE risk scores than in patients with low GRACE risk scores ( = 0.006). ROC curve analysis showed that the GRACE risk score has moderate value in predicting MACE in NSTE-MINOCA patients. The area under the ROC curve was 0.710 (95% CI 0.625-0.796, < 0.001). The GRACE risk score provides potentially valuable prognostic information on clinical outcome when applied to MINOCA patients with NSTE.
非阻塞性冠状动脉心肌梗死（MINOCA）是一种特殊类型的心肌梗死（MI）。GRACE风险评分常用于预测非ST段抬高型心肌梗死患者的主要不良心血管事件（MACE），而GRACE风险评分在MINOCA患者预后分层中的适用性仍不确定。本研究旨在调查GRACE风险评分是否能够预测NSTE的MINOCA患者的MACE。我们计算了340例连续的NSTE的MINOCA患者的GRACE风险评分。根据GRACE风险评分，患者被分为低-中风险组（≤140，48.8%）和高风险组（>140，51.2%）。评估了患者的临床特征和结局。高风险组的患者往往年龄更大且合并症更多。在1年随访时，高风险组的心源性死亡率显著高于低-中风险组（=0.010）。在非致命性MI、中风、心力衰竭或心血管相关再住院方面无显著差异。GRACE风险评分高的患者的总MACE发生率显著高于GRACE风险评分低的患者（=0.006）。ROC曲线分析表明，GRACE风险评分在预测NSTE-MINOCA患者的MACE方面具有中等价值。ROC曲线下面积为0.710（95%CI 0.625-0.796，<0.001）。当应用于NSTE的MINOCA患者时，GRACE风险评分可为临床结局提供潜在有价值的预后信息。
