Yan Ju, Deng Chang-Jiang, Wang Si-Fan, Aimaitijiang Mikereyi, Wu Ting-Ting, Zheng Ying-Ying, Xie Xiang, Ma Yi-Tong
Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China.
Rev Cardiovasc Med. 2023 Jun 6;24(6):161. doi: 10.31083/j.rcm2406161. eCollection 2023 Jun.
To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system.
We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital's electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves.
Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant ( 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score.
The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system.
NCT02737956.
建立一种改良的全球急性冠状动脉事件注册（GRACE）评分系统，使其预测性能优于传统GRACE评分系统。
通过新疆医科大学第一附属医院心脏中心的医院电子病历系统，我们确定了2015年1月1日至2020年12月31日期间因确诊急性心肌梗死（AMI）住院的5512例患者。应用纳入和排除标准后，共纳入4561例患者。平均随访时间为51.8±23.4个月。根据终点事件将患者分为死亡组和存活组。使用两样本t检验和卡方检验比较两组之间的差异。将调整后的传统危险因素以及LogBNP（B型利钠肽前体，BNP）和改良的GRACE评分系统纳入多因素COX回归模型。通过受试者操作特征（ROC）曲线比较传统GRACE评分系统和改良GRACE评分系统的预测性能。
通过两样本t检验发现，死亡组和存活组在年龄、心率、肌酐、尿酸、LogBNP、传统GRACE评分和改良GRACE评分方面存在显著差异。通过卡方检验比较两组发现，死亡组男性发病率更高；心功能分级更高；有高血压、糖尿病、冠状动脉疾病（CAD）或脑血管疾病病史；有吸烟史；需要主动脉内球囊泵（IABP）支持；服用阿司匹林、氯吡格雷、替格瑞洛和β受体阻滞剂的患者更多。通过多因素COX回归模型分析结果，在调整混杂因素后，发现年龄、心功能分级、CAD病史、阿司匹林和β受体阻滞剂的使用以及改良的GRACE评分系统与AMI患者的全因死亡率（ACM）相关。使用ROC曲线比较传统GRACE评分系统和改良GRACE评分系统的预测性能，发现改良的GRACE评分系统（曲线下面积（AUC）=0.809，P<0.001，95%置信区间（CI）（0.789 - 0.829））显著优于传统GRACE评分系统（AUC = 0.786，P<0.001，95%CI（0.764 - 0.808）），两个评分之间的比较具有统计学意义（P<0.001）。改良GRACE评分经过10倍交叉内部验证后C统计量的变化不显著，新旧模型之间的综合判别改善（IDI）计算为IDI = 0.019>0，表明改良GRACE评分对传统GRACE评分有正向改善。
通过结合B型利钠肽前体（BNP）和传统GRACE评分系统建立的改良GRACE评分系统与AMI患者的ACM独立相关，其AUC比传统GRACE评分系统更大，预测价值更高。
NCT02737956。
