Fedele Damiano, Canton Lisa, Bodega Francesca, Suma Nicole, Tattilo Francesco Pio, Impellizzeri Andrea, Amicone Sara, Di Iuorio Ornella, Ryabenko Khrystyna, Armillotta Matteo, Sansonetti Angelo, Stefanizzi Andrea, Cavallo Daniele, Casuso Marcello, Bertolini Davide, Lovato Luigi, Gallinoro Emanuele, Belmonte Marta, Rinaldi Andrea, Angeli Francesco, Casella Gianni, Foà Alberto, Bergamaschi Luca, Paolisso Pasquale, Pizzi Carmine
Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
J Clin Med. 2023 Aug 31;12(17):5687. doi: 10.3390/jcm12175687.
: the prognosis of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not benign; thus, prompting the need to validate prognostic scoring systems for this population. : to evaluate and compare the prognostic performance of GRACE, TIMI, HEART, and ACEF scores in MINOCA patients. : A total of 250 MINOCA patients from January 2017 to September 2021 were included. For each patient, the four scores at admission were retrospectively calculated. The primary outcome was a composite of all-cause death and acute myocardial infarction (AMI) at 1-year follow-up. The ability to predict 1-year all-cause death was also tested. : Overall, the tested scores presented a sub-optimal performance in predicting the composite major adverse event in MINOCA patients, showing an AUC ranging between 0.7 and 0.8. Among them, the GRACE score appeared to be the best in predicting all-cause death, reaching high specificity with low sensitivity. The best cut-off identified for the GRACE score was 171, higher compared to the cut-off of 140 generally applied to identify high-risk patients with obstructive AMI. When the scores were tested for prediction of 1-year all-cause death, the GRACE and the ACEF score showed very good accuracy (AUC = 0.932 and 0.828, respectively). the prognostic scoring tools, validated in AMI cohorts, could be useful even in MINOCA patients, although their performance appeared sub-optimal, prompting the need for risk assessment tools specific to MINOCA patients.
非阻塞性冠状动脉心肌梗死（MINOCA）患者的预后并非良好；因此，需要验证针对该人群的预后评分系统。为了评估和比较GRACE、TIMI、HEART和ACEF评分在MINOCA患者中的预后性能。纳入了2017年1月至2021年9月期间的250例MINOCA患者。对每位患者回顾性计算入院时的四个评分。主要结局是1年随访时全因死亡和急性心肌梗死（AMI）的复合结局。还测试了预测1年全因死亡的能力。总体而言，所测试的评分在预测MINOCA患者的复合主要不良事件方面表现欠佳，AUC在0.7至0.8之间。其中，GRACE评分在预测全因死亡方面似乎最佳，特异性高但敏感性低。确定的GRACE评分最佳临界值为171，高于通常用于识别阻塞性AMI高危患者的140临界值。当测试这些评分对1年全因死亡的预测能力时，GRACE和ACEF评分显示出非常好的准确性（AUC分别为0.932和0.828）。在AMI队列中验证的预后评分工具，即使在MINOCA患者中也可能有用，尽管其性能似乎欠佳，这表明需要针对MINOCA患者的风险评估工具。
