Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study
| Autor: | Shadi Mahdiani, Markku Eskola, Niku Oksala, Kari Antila, Markus Hautamäki, Jussi Hernesniemi, Terho Lehtimäki, Leo-Pekka Lyytikäinen, Kjell Nikus, Nina Syyli |
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| Přispěvatelé: | Lääketieteen ja terveysteknologian tiedekunta - Faculty of Medicine and Health Technology, Tampere University |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Scoring system Coronary Artery Disease 030204 cardiovascular system & hematology acute coronary syndrome 03 medical and health sciences 0302 clinical medicine Paired samples Internal medicine medicine 030212 general & internal medicine First episode Framingham Risk Score Ejection fraction Proportional hazards model business.industry Sisätaudit - Internal medicine left ventricular ejection fraction prediction medicine.disease mortality Cardiology Cardiology and Cardiovascular Medicine business Clinical risk factor |
| Zdroj: | Open Heart Syyli, N, Markus, H, Antila, K, Mahdiani, S, Eskola, M, Lehtimäki, T, Nikus, K, Lyytikäinen, L-P, Oksala, N & Hernesniemi, J 2019, ' Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS : The MADDEC study ', Open Heart, vol. 6, no. 1, e001007, pp. e001007 . https://doi.org/10.1136/openhrt-2019-001007 |
| ISSN: | 2053-3624 |
| DOI: | 10.1136/openhrt-2019-001007 |
| Popis: | BackgroundReduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting.MethodsA retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015–2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong’s method for paired samples and by index of discrimination improvement (IDI).ResultsIn univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031).ConclusionsAdding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS. |
| Databáze: | OpenAIRE |
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