Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
J Cardiol. 2021 Sep;78(3):201-205. doi: 10.1016/j.jjcc.2021.04.005. Epub 2021 May 2.
Recent guidelines recommend risk stratification using objective scoring systems in patients with acute coronary syndrome. In this context, the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) and GRACE (Global Registry of Acute Coronary Events) risk scores were both originally established to predict short-term mortality. However, their impact on short- and long-term clinical outcomes in a contemporary cohort of patients with acute myocardial infarction (MI) is unclear.
This bi-center registry included 809 patients with acute MI undergoing primary percutaneous coronary intervention. Patients were divided into three groups according to the pre-defined thresholds and tertiles of the CADILLAC and GRACE scores. The study endpoints included all-cause death and major adverse cardiovascular events (MACE) during the index hospitalization and after discharge.
Of 809 patients, 323 (39.9%) and 255 (31.5%) had high CADILLAC and GRACE risk scores. During the index hospitalization, 61 (7.5%) patients died and 262 (32.4%) had MACE. Both CADILLAC and GRACE risk scores were associated with in-hospital mortality and MACE rates. After discharge, out of 683 patients with available follow-up information who survived to discharge, 42 (6.1%) died and 123 (18.0%) had MACE during the median follow-up period of 632 days. Significantly higher incidence of MACE in higher CADILLAC and GRACE risk scores was observed in a stepwise manner.
Both CADILLAC and GRACE risk scores were predictive for short- and long-term mortality and MACE rates in a contemporary cohort of acute MI patients undergoing primary percutaneous coronary intervention.
近期指南建议在急性冠状动脉综合征患者中使用客观评分系统进行风险分层。在此背景下，CADILLAC（依替巴肽控制的冠状动脉成形术和装置降低晚期并发症）和 GRACE（全球急性冠状动脉事件注册）风险评分最初都是为预测短期死亡率而建立的。然而，它们在接受直接经皮冠状动脉介入治疗的急性心肌梗死（MI）患者当代队列中的短期和长期临床结局中的影响尚不清楚。
本双中心注册研究纳入 809 例接受直接经皮冠状动脉介入治疗的急性 MI 患者。根据 CADILLAC 和 GRACE 评分的预定义阈值和三分位数，将患者分为三组。研究终点包括住院期间和出院后的全因死亡和主要不良心血管事件（MACE）。
809 例患者中，323 例（39.9%）和 255 例（31.5%）患者的 CADILLAC 和 GRACE 评分较高。住院期间，61 例（7.5%）患者死亡，262 例（32.4%）发生 MACE。CADILLAC 和 GRACE 评分均与住院期间的死亡率和 MACE 发生率相关。出院后，在 683 例有可用随访信息且存活至出院的患者中，42 例（6.1%）死亡，123 例（18.0%）在中位随访 632 天期间发生 MACE。CADILLAC 和 GRACE 评分较高的患者，MACE 的发生率呈逐步升高趋势。
CADILLAC 和 GRACE 评分均能预测直接经皮冠状动脉介入治疗的急性 MI 患者的短期和长期死亡率及 MACE 发生率。
