Limits...
Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention.

Liu XJ, Wan ZF, Zhao N, Zhang YP, Mi L, Wang XH, Zhou D, Wu Y, Yuan ZY - Cardiovasc Diabetol (2015)

Bottom Line: Cumulative MACE curve was calculated using the Kaplan-Meier method.Multivariate Cox regression was used to identify predictors of MACEs.During a median of 42.3 months (interquartile range 39.3-44.2 months), 16 (2.9%) were lost to follow-up, and patients experienced 69 (12.9%) MACEs: 51 (9.6%) all-cause deaths and 18 (3.4%) nonfatal myocardial infarction cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. liuxjchina@163.com.

ABSTRACT

Background: The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI).

Methods: We enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman's rank correlation. Cumulative MACE curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: During a median of 42.3 months (interquartile range 39.3-44.2 months), 16 (2.9%) were lost to follow-up, and patients experienced 69 (12.9%) MACEs: 51 (9.6%) all-cause deaths and 18 (3.4%) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95% CI 1.020-1.040; p < 0.001; 3.530; 95% CI 1.927-6.466; p < 0.001, respectively). Furthermore, Kaplan-Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001].

Conclusions: HbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic (ROC) curve analysis. The addition of HbA1c content to the GRACE score as continuous variables could improve the predictive power for long-term MACEs (area under the ROC curve for GRACE score alone, 0.75; combined with HbA1c content, 0.80; z value 2.521, p = 0.012)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4541750&req=5

Fig2: Receiver operating characteristic (ROC) curve analysis. The addition of HbA1c content to the GRACE score as continuous variables could improve the predictive power for long-term MACEs (area under the ROC curve for GRACE score alone, 0.75; combined with HbA1c content, 0.80; z value 2.521, p = 0.012)

Mentions: Since both HbA1c content and GRACE score were independent risk factors of a MACE, we assessed the effect of their combination on predicting long-term risk of MACE occurrence. The AUC increased from 0.75 (95 % CI 0.69–0.82) for GRACE score alone to 0.80 (95 % CI 0.75–0.85) for GRACE score adjustment by HbA1c content (difference in the AUCs, 0.05; z value 2.521, p = 0.012) (Fig. 2). Addition of HbA1c content improved GRACE score alone model discrimination, which was confirmed by the IDI and the continuous, category-free NRI (>0). The IDI for HbA1c content was 0.055 (95 % CI 0.035–0.075, P < 0.001), suggesting further average separation of events from non-events by the HbA1c; the NRI (>0) for HbA1c content was 0.70, (95 % CI 0.47–0.94, P < 0.001), with events contributing 0.42 and non-events 0.28 (Table 4), showing that the HbA1c content led to a significant net reclassification of patients, risk in the appropriate directions.Fig. 2


Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention.

Liu XJ, Wan ZF, Zhao N, Zhang YP, Mi L, Wang XH, Zhou D, Wu Y, Yuan ZY - Cardiovasc Diabetol (2015)

Receiver operating characteristic (ROC) curve analysis. The addition of HbA1c content to the GRACE score as continuous variables could improve the predictive power for long-term MACEs (area under the ROC curve for GRACE score alone, 0.75; combined with HbA1c content, 0.80; z value 2.521, p = 0.012)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4541750&req=5

Fig2: Receiver operating characteristic (ROC) curve analysis. The addition of HbA1c content to the GRACE score as continuous variables could improve the predictive power for long-term MACEs (area under the ROC curve for GRACE score alone, 0.75; combined with HbA1c content, 0.80; z value 2.521, p = 0.012)
Mentions: Since both HbA1c content and GRACE score were independent risk factors of a MACE, we assessed the effect of their combination on predicting long-term risk of MACE occurrence. The AUC increased from 0.75 (95 % CI 0.69–0.82) for GRACE score alone to 0.80 (95 % CI 0.75–0.85) for GRACE score adjustment by HbA1c content (difference in the AUCs, 0.05; z value 2.521, p = 0.012) (Fig. 2). Addition of HbA1c content improved GRACE score alone model discrimination, which was confirmed by the IDI and the continuous, category-free NRI (>0). The IDI for HbA1c content was 0.055 (95 % CI 0.035–0.075, P < 0.001), suggesting further average separation of events from non-events by the HbA1c; the NRI (>0) for HbA1c content was 0.70, (95 % CI 0.47–0.94, P < 0.001), with events contributing 0.42 and non-events 0.28 (Table 4), showing that the HbA1c content led to a significant net reclassification of patients, risk in the appropriate directions.Fig. 2

Bottom Line: Cumulative MACE curve was calculated using the Kaplan-Meier method.Multivariate Cox regression was used to identify predictors of MACEs.During a median of 42.3 months (interquartile range 39.3-44.2 months), 16 (2.9%) were lost to follow-up, and patients experienced 69 (12.9%) MACEs: 51 (9.6%) all-cause deaths and 18 (3.4%) nonfatal myocardial infarction cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. liuxjchina@163.com.

ABSTRACT

Background: The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI).

Methods: We enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman's rank correlation. Cumulative MACE curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: During a median of 42.3 months (interquartile range 39.3-44.2 months), 16 (2.9%) were lost to follow-up, and patients experienced 69 (12.9%) MACEs: 51 (9.6%) all-cause deaths and 18 (3.4%) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95% CI 1.020-1.040; p < 0.001; 3.530; 95% CI 1.927-6.466; p < 0.001, respectively). Furthermore, Kaplan-Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001].

Conclusions: HbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI.

No MeSH data available.


Related in: MedlinePlus