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.
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.
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通过血红蛋白 A1c 调整 GRACE 评分，可以更准确地预测急性冠状动脉综合征的长期主要不良心脏事件，而无需接受经皮冠状动脉介入治疗的糖尿病患者
DOI：
10.1186/s12933-015-0274-4
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发表时间：
2015-08-19
影响因子：
9.3
通讯作者：
Yuan ZY
中科院分区：
文献类型：
--
作者：
Liu XJ;Wan ZF;Zhao N;Zhang YP;Mi L;Wang XH;Zhou D;Wu Y;Yuan ZY
研究背景全球急性冠脉事件登记处（GRACE）风险评分被广泛推荐用于急性冠脉综合征（ACS）患者的风险评估。慢性高血糖[血红蛋白A1 c（HbA 1c）]可独立预测ACS患者的主要不良心脏事件（MACE）。我们调查是否可以改善与GRACE评分的MACE预测与糖化血红蛋白含量在ACS患者无糖尿病（DM）接受经皮冠状动脉介入治疗（PCI）。MethodsWe纳入549例ACS患者无DM接受PCI。入院时测定GRACE评分和HbA 1c含量。相关性分析采用斯皮尔曼等级相关。使用Kaplan-Meier方法计算累积MACE曲线。多变量考克斯回归用于确定MACE的预测因素。此外，通过受试者工作特征曲线下面积（AUC）、持续净再分类改善（NRI）和综合辨别力改善（IDI）评估HbA 1c含量单独和与GRACE评分联合的预测价值。（四分位距39.3-44.2个月），16例（2.9%）失访，患者发生69例（12.9%）MACE：51例（9.6%）全因死亡和18例（3.4%）非致死性心肌梗死病例。GRACE评分与HbA 1c含量呈正相关。多变量考克斯分析显示GRACE评分和HbA 1c含量均为MACE的独立预测因素（风险比分别为1.030; 95% CI 1.020-1.040;p< 0.001; 3.530; 95% CI 1.927-6.466;p< 0.001）。Kaplan-Meier分析显示，随着HbA 1c含量的增加，MACE的风险增加（log-rank 33.906，p < 0.001）。通过HbA 1c调整GRACE风险评估改善了GRACE评分的预测值[AUC从GRACE评分的0.75增加到GRACE评分加HbA 1c的0.80，p= 0.012; IDI = 0.055，p < 0.001; NRI（>0）= 0.70，p < 0.001]。结论HbA 1c含量与GRACE危险评分呈正相关，二者联合可进一步改善非糖尿病ACS患者PCI的危险分层。
BackgroundThe 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).MethodsWe 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).ResultsDuring 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].ConclusionsHbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI.