Morishita Tetsuji, Uzui Hiroyasu, Mitsuke Yasuhiko, Tada Hiroshi
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka, Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Department of Cardiovascular Medicine, National Hospital Organization Awara Hospital, 238-1 Kitagata, Awara, Fukui, 910-4272, Japan.
Heart Vessels. 2023 Jan;38(1):8-17. doi: 10.1007/s00380-022-02126-8. Epub 2022 Jul 7.
The utility of adding information on 1,5-anhydro-D-glucitol (1,5-AG), a marker for postprandial hyperglycemia, to a pre-existing scoring system in acute coronary syndrome (ACS) patients is unknown. This retrospective cohort study included 266 ACS patients. The end point was major adverse cardiac and cerebral events (MACCE) through 5 years of follow-up. To evaluate incremental benefits of combining 1,5-AG with the syntax score, we applied time-dependent receiver operating curve (ROC) analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI) and decision curve analysis (DCA). Temporal changes to the area under time-dependent ROC curves showed that addition of 1,5-AG parameters to syntax score did not provide any incremental value (area under the curve for syntax alone, 0.673 (95% confidence interval (CI), 0.599-0.747) vs. with 1,5-AG combined, 0.671 (95%CI 0.596-0.746; Delong p = 0.65). Incorporating 1,5-AG into syntax score yielded a significant NRI of 0.291 (95%CI 0.015-0.567) and IDI of 0.055 (95%CI 0.018-0.093), while DCA analysis showed the limited net benefit in combination with 1,5-AG and syntax score. 1,5-AG values exhibited significant discriminatory utility for detecting MACCE within the ACS population. However, 1,5-AG levels contributed limited utility beyond syntax score based on time-dependent ROC and DCA analyses.Trial registration: UMIN000023837.
在急性冠状动脉综合征（ACS）患者预先存在的评分系统中添加餐后高血糖标志物1,5 - 脱水-D-葡萄糖醇（1,5-AG）信息的效用尚不清楚。这项回顾性队列研究纳入了266例ACS患者。终点是5年随访期间的主要不良心脑血管事件（MACCE）。为了评估将1,5-AG与SYNTAX评分相结合的增量益处，我们应用了时间依赖性受试者工作特征曲线（ROC）分析、净重新分类改善（NRI）、综合判别改善（IDI）和决策曲线分析（DCA）。时间依赖性ROC曲线下面积的时间变化表明，将1,5-AG参数添加到SYNTAX评分中未提供任何增量价值（仅SYNTAX评分的曲线下面积为0.673（95%置信区间（CI），0.599 - 0.747），与1,5-AG联合时为0.671（95%CI 0.596 - 0.746；德龙p = 0.65）。将1,5-AG纳入SYNTAX评分产生了显著的NRI为0.291（95%CI 0.015 - 0.567）和IDI为0.055（95%CI 0.018 - 0.093），而DCA分析显示与1,5-AG和SYNTAX评分联合时净益处有限。1,5-AG值在检测ACS人群中的MACCE方面表现出显著的判别效用。然而，基于时间依赖性ROC和DCA分析，1,5-AG水平在SYNTAX评分之外的效用有限。试验注册：UMIN000023837。
