The GRACE risk score predicts no-reflow and MACE in patients with STEMI undergoing PCI / 西安交通大学学报(医学版)

【Objective】 Coronary no-reflow during percutaneous conranary intervention (PCI) often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events (MACE). The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI. 【Methods】 We consecutively recruited 1 118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011. Main demographic data, cardiovascular risk factors, blood lipid and other biochemical indicators were recorded. Coronary angiography was performed by a radial artery approach using the standard Judkins technique. Coronary no-reflow was evaluated by at least two independent experienced cardiologists. The GRACE risk score was calculated with a computer program. All the cases were followed up by medical records, face-to-face interviews or telephone calls. Finally, we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI. 【Results】 During a median period of 36 months, 58 of the 1 118 patients (5.2%) were lost to follow-up. Of the remaining 1 060 patients, 118 (11.1%) had no-reflow and 147 (13.9%) had MACE. The GRACE score was higher in patients with no-reflow than those without no-reflow. Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow (OR=1.034; P=0.002). And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE. The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697, respectively. Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure, reinfarction, all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score. 【Conclusion】 The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.

Predictive Value of TIMI Risk Index for Angiographic No-reflow after Primary Percutaneous Coronary Intervention

Objective: In patients with acute coronary artery disease, the TIMI risk index (TRI), the thrombolysis in myocardial infarction (TIMI) risk score, and the global registry of acute coronary events (GRACE) risk score (GRS) have all been documented. The aim of this study was to determine the relationship between no-reflow (NRF) and admission TRI, major cardiac events (MACE), and in-hospital mortality in patients undergoing primary percutaneous coronary intervention (P-PCI). Methods: Between March and December 2019, 100 consecutive patients diagnosed with STEMI and treated with PPCI at Tanta Main University Hospital in Tanta, Egypt, were included in the research population. Each patient consented following a thorough history taking, evaluation of coronary risk factors, clinical examination, and electrocardiogram analysis. Additionally, all instances were classified using the Killip method. The GRS, TRS, and TRI values were examined. Results: The GRS, TRS, and TRI scores were significantly associated with increased NRF, MACE, and hospital mortality in STEMI patients treated with P-PCI, suggesting that TRI is a straightforward indicator with fewer parameters that accurately reflects P-PCI success. Conclusion: TRI has been demonstrated to enhance the risk of in-hospital mortality and MACE. TRI uses straightforward and cost-effective ways to test patients who have experienced a STEMI. Additionally, a high TRI may assist in identifying high-risk individuals and developing suitable treatment solutions.

Study on the correlation between acute coronary event registration (GRACE) risk score and laboratory index in AMI patients / 中国基层医药

Objective@#To investigate the association between acute global coronary event registration(GRACE) risk score and laboratory parameters in patients with acute myocardial infarction(AMI).@*Methods@#A retrospective analysis of 128 patients with AMI who admitted in Wenling Hospital of Traditional Chinese Medicine from May 2014 to May 2016 was performed.Among them, 86 patients with ST-segment elevation myocardial infarction were included in A group, and 42 patients with non-ST-segment elevation myocardial infarction were included in B group.According to the GRACE score at admission, they were divided into low, medium and high risk groups.The correlation between the patients' GRACE score and laboratory indicators was analyzed.@*Results@#There were statistically significant differences in gender, alcohol consumption, age, PRBC and GRACE scores between A group and B group(χ2=4.071, 4.096, t=3.594, 2.378, 2.657, all P<0.05). According to age, GRACE and PRBC, the area under the ROC curve was 0.738(95% CI: 0.603~0.765, P<0.05). The male, smoking, drinking, age, D-dimer, PRBC, FDP, RDW and MCV had statistically significant differences among the low, medium and high risk groups(χ2=8.225, 11.450, 3.739, F=73.311, 146.980, 86.414, 10.512, 3.981, 5.786, all P<0.05). The correlation analysis showed that the GRACE score had positive correlation with age, MPV, PCT, MCV, RDW, PRBC, FDP and D-dimer (r=0.712, 0051, 0.128, 0.134, 0.039, 0.157, 0.279, 0.286, all P<0.05). The multiple linear regression analysis showed that the independent risk factors for GRACE scores were age and FDP.@*Conclusion@#There are significant differences in age, gender, drinking history, PRBC and GRACE scores between ST-segment elevation myocardial infarction patients and non-ST-segment elevation myocardial infarction patients, and there is a significant correlation between GRACE scores and laboratory test indicators.

Study on the correlation between acute coronary event registration ( GRACE) risk score and laboratory index in AMI patients / 中国基层医药

Objective To investigate the association between acute global coronary event registration (GRACE) risk score and laboratory parameters in patients with acute myocardial infarction ( AMI).Methods A retrospective analysis of 128 patients with AMI who admitted in Wenling Hospital of Traditional Chinese Medicine from May 2014 to May 2016 was performed.Among them,86 patients with ST－segment elevation myocardial infarction were included in A group,and 42 patients with non －ST －segment elevation myocardial infarction were included in B group.According to the GRACE score at admission ,they were divided into low,medium and high risk groups.The correlation between the patients ＇GRACE score and laboratory indicators was analyzed.Results There were statistically significant differences in gender ,alcohol consumption ,age,PRBC and GRACE scores between A group and B group(χ2 ＝4.071,4.096,t＝3.594,2.378,2.657,all P＜0.05).According to age,GRACE and PRBC,the area under the ROC curve was 0.738 (95% CI:0.603 ～0.765, P ＜0.05).The male, smoking, drinking,age, D－dimer,PRBC,FDP,RDW and MCV had statistically significant differences among the low ,medium and high risk groups(χ2 ＝8.225,11.450,3.739,F ＝73.311,146.980,86.414,10.512,3.981,5.786,all P ＜0.05).The correlation analysis showed that the GRACE score had positive correlation with age ,MPV,PCT,MCV,RDW,PRBC, FDP and D－dimer (r＝0.712,0051,0.128,0.134,0.039,0.157,0.279,0.286,all P＜0.05).The multiple linear regression analysis showed that the independent risk factors for GRACE scores were age and FDP .Conclusion There are significant differences in age ,gender,drinking history,PRBC and GRACE scores between ST －segment elevation myocardial infarction patients and non －ST －segment elevation myocardial infarction patients , and there is a significant correlation between GRACE scores and laboratory test indicators.

Comparison of HEART and GRACE scores for 30-day predictive value in patients with acute chest pain in emergency department / 中华急诊医学杂志

Objective To evaluate the predictive value of HEART and GRACE scores for risk stratification and 30-day major adverse cardiovascular events (MACE) in patients with acute chest pain in emergency department.Methods This is a prospective observational study.Patients with acute chest pain aged 18 years or older who were first diagnosed in our emergency department were enrolled from January 1,2016 to September 1,2017.The clinical data were collected,and HEART and GRACE scores were calculated.All causes of MACE in each patient were followed up for 30 days.Results This study included 1004 patients with acute chest pain for analysis.Finally this study enrolled 600 patients with an age range of 20-98 years (mean 63.28±15.47 years),351 males (58.5％) and 249 females (41.5％).The age,past history (smoking,coronary heart disease and diabetes),GRACE score and HEART score in MACE patients were significantly higher than those in non-MACE patients (P＜0.05).The area under the ROC curve of HEART and GRACE scores were 0.817 (95％ CI 0.771-0.863) and 0.739 (95％ CI:0.687-0.791),respectively.The percent of patients with 30-day MACE with GRACE score and HEART score were 6.2％ vs 4.1％ in low-risk stratification,19.7％ vs 15.1％ in medium-risk stratification,and 35.1％ vs 56.5％ in high-risk stratification,respectively.Conclusions The HEART score is superior to the GRACE score in predicting 30-day MACE in patients with acute chest pain in emergency department.

Sesgo en la estratificación del síndrome coronario agudo al calcular el grace- score con 1ª, 2ª o troponina Δ / Grace score bias in acute coronary syndrome due to use 1th, 2th or troponin Δ

Introducción: el síndrome coronario agudo (SCA) es la primera causa de mortalidad en Colombia. Una estratificación de riesgo errónea, en la sala de emergencias (ER), afecta las intervenciones realizadas y la tasa de eventos adversos cardiovasculares puede ser mayor. El objetivo de esta investigación fue medir la diferencia en el puntaje GRACE y la estratificación del riesgo coronario, utilizando los resultados de las troponinas medidas secuencialmente durante la atención inicial. Metodología: con un diseño descriptivo retrospectivo, se evaluaron los registros clínicos de pacientes tratados por dolor precordial de probabilidad intermedia para SCA, sin indicación de manejo invasivo inmediato, atendidos en la sala de emergencias de una clínica del tercer nivel de Bogotá, durante el año 2017. Se determinó la diferencia entre la puntuación GRACE calculada con la primera troponina (GRACE-1), la segunda troponina (GRACE-2) o la troponina delta (GRACE-delta) [prueba T pareada], y la proporción de pacientes poco estratificados se midió al usar la primera troponina [X2, puntaje Z]. Resultados: se identificaron 44 pacientes en un período de 6 meses. La mayoría hombres con edad mediana de 73 años. El promedio (DE) de los puntajes GRACE-1, GRACE-2 y GRACE-delta, fue de 114.14 (30.73), 115.55 (30.14) y 111.11 (28.79), respectivamente; al comparar GRACE-delta con GRACE-1 y GRACE-2 se identificaron diferencias significativas (p:<0.05). Se identificó un error en la estratificación del riesgo coronario en 10/44 pacientes (22.7%) y 9/44 (20.4%) presentaron sobreestratificación. Conclusión: la estratificación del riesgo coronario con la primera troponina, a diferencia de la troponina delta (ítem no aclarado en las guías), evidenció una sobreestratificación en al menos 20% de los pacientes, estableciendo la necesidad de procedimientos más invasivos y posiblemente hospitalización más prolongada permanecer.

Background: Acute coronary syndrome (ACS) is the first cause of mortality in Colombia. An erroneous risk stratification, in the emergency room (ER), affects the interventions performed and the rate of major cardiovascular adverse events. We measured the difference in GRACE score and stratification of coronary risk, by using the results of troponins measured sequentially during initial care. Methods: With a retrospective descriptive design, clinical records of patients treated for precordial pain of ≥ intermediate probability for ACS were evaluated, without indication of immediate invasive management, attended in the ER of a clinic of the third level of Bogotá, during 2017. De-termined the difference between the GRACE score calculated with the first (GRACE-1), second (GRACE-2) or troponin delta (GRACE-delta [paired T-test], and the proportion of poorly stratified patients was measured when using the first troponin [X2, Z-score]. Results: 44 patients in a period of 6 months were identified. The majority men, older adults, middle age 73 years. The average (SD) of scores GRACE-1, GRACE-2 and GRACE-delta, was 114.14 (30.73), 115.55 (30.14) and 111.11 (28.79), respectively; when comparing GRACE-delta with GRACE-1 and GRACE-2 significant differences were identified (p:<0.05). Error in the stratification of coronary risk was identified in 10/44 patients (22.7%), and 9/44 (20.4%) presented over-stratification. Conclusion: The stratification of coronary risk using the first troponin, unlike the troponin delta (item not clarified in the guidelines), evidenced an over-stratification in at least 20% of the patients, establishing the need for more invasive procedures and possibly longer hospital stay.

The roles of high mobility group box1 and GRACE score in clinical prognosis of acute coronary syndrome patients undergoing selective percutaneous coronary intervention / 实用医学杂志

Objective To investigate the impact of high mobility group box1 and GRACE score on the clinical prognosis of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention. Methods A total of 380 consecutive patients initially diagnosed with acute coronary syndrome undergoing selec-tive PCI between January 2014 and March 2015 were included,with 200 of them assigned into low high mobility group box1(HMGB1<445 ng/mL)and the other 180 patients into high mobility group box1(HMGB1≥445 ng/mL).The baseline characteristics and laboratory indexes were collected on admission,GRACE score were calculat-ed at admission.The difference between the high and low high mobility group box1 were analzyed and the influenc-ing factors of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention were studied. The mean follow-up period was 24 months,and the clinical end points were deaths from various causes and readmission for coronary heart disease. Results There were significantly differences statistically between the groups of high and low high mobility group box1 in clinical diagnosis. lipoprotein associated phospholipase A2, GRACE score,mean platelet volume,red cell distribution width,age,and left ventricular ejection fraction(P <0.05). The correlation analysis showed that HMGB1 was significantly related to lipoprotein associated phospholi-pase A2 and GRACE score,with the correlation coefficents of 0.575,0.836,respectively(P<0.05).COX analy-sis showed that HMGB1,lipoprotein associated phospholipase A2,GRACE score had statistical significance for survival outcomes(P<0.05),and the area under the ROC curve drawn by combining the three was 0.851(95% CI 0.811 ~ 0.891,P < 0.05). Conclusion There was a good correlation between HMGB1 and GRACE score. HMGB1 is a good predictor of clinical outcomes in the patients with acute coronary syndromes undergoing elective PCI treatment.

Clinical characteristics in patients with acute coronary syndrome and analysis of prognostic factors / 重庆医学

Objective To study the clinical characteristics in the patients with different types of acute coronary syndrome(ACS) undergoing percutaneous coronary intervention (PCI) and the factors affecting the PCI treatment.Methods A total of 377 inpatients with ACS undergoing PCI in this hospital from January 2014 to March 2015 were selected,including 172 cases of ST-elevation acute coronary syndrome (ST-ACS) group and 205 cases of non-ST-elevation ACS (NST-ACS group).The baseline data and detection indexes were collected,the GRACE score on admission was calculated,the database was established,regular follow-up was performed,and the prognosis was analyzed.Results The smoking history,emergency PCI,coronary angi-ography TIMI grade ≤ 1,H MGB1,GRACE score,heart rate on admission,white blood cell(WBC) count,neutrophil ratio,lymphocyte ratio,monocytes ratio,absolute neutrophil count,high density lipoprotein,apolipoprotein b,number of lesion vessels and left ventricular ejection fraction had statistical differences between the ST-ACS group and NST-ACS group (P ＜ 0.05);the correlation analysis showed that HMGB1 and GRACE score were significantly correlated (r=0.836,P＜0.01).The 2-year follow-up results showed that the previous myocardialinfarction and PCI history,Killip grade(Ⅱ-Ⅳ),coronary angiography TIMI grade≤ 1,HMGB1,GRACE score,mean platelet volume,age and number of lesion vessels had differences between the end point event occurrence group and end point event non-occurrence group (P＜0.05).The Logistic regression analysis showed that HMGB1,GRACE score,age,previous PCI histoty,Killip grade (Ⅱ-IV) were the independent risk factors for cardiovascular events (P ＜ 0.05).The Cox survival analysis showed that HMGB1,previous PCI history,Killip grade (Ⅱ-Ⅳ) were the independent risk factors for cardiovascular events (P＜0.05).The ROC survival curve showed that the accuracy of HMGB1 was good,the areas under the curve was 0.844 (95％CI:0.803-0.885,P＜0.05),the critical value predicting the end point events was 480.44 ng/mL.Conclusion HMGB1 has difference between the ST-ACS group and NST-ACS group,and has a good correlation with GRACE score.

Predictive value of the GRACE discharge score on the long-term out-of-hospital coronary thrombotic events after implantation of drug-eluting stents / 中华心血管病杂志

Objective@#To evaluate the predictive value of GRACE discharge score on the long-term out-of-hospital coronary thrombotic events (CTE) after percutaneous coronary intervention (PCI) with drug-eluting stents.@*Methods@#Present study was a prospective, observational, single center study. 10 724 consecutive patients underwent PCI in Fuwai Hospital between January and December 2013 were included, stents were implanted with conventional method. After PCI, patients were prescribed aspirin 100 mg once daily indefinitely, and either clopidogrel 75 mg once daily or ticagrelor 90 mg twice daily for at least 1 year. A total of 9 782 patients were included in the final analysis after excluding patients who did not undergo successful stent implantation, who were not discharged on dual anti-platelet therapy (DAPT), who only underwent bare-metal stents, who experienced in-hospital major bleeding, stent thrombosis, myocardial infarction (MI) or death,and who lost follow up. Clinical data were collected from all patients. 9 543 patients with complete baseline data were further analyzed for risk stratification and predictive value of GRACE discharge score. CTE was defined as stent thrombosis or spontaneous myocardial infarction. All patients were followed through Fuwai Hospital Follow-up Center, and evaluated either by phone, letter, or clinic visits or at 1, 6, 12 and 24 months after PCI. Risk stratification was performed according to the GRACE discharge score, and the predictive value of the GRACE discharge score was assessed using the receiver operating characteristic (ROC) curve.@*Results@#After 2 years follow-up, there were 95 CTE among the 9 782 patients. The patients were divided into 2 groups according to the presence or absence of CTE: CTE group (95 cases) and no CTE group (9 687 cases). GRACE discharge score was significantly higher in CTE group than no CTE group (82.98±27.58 vs. 75.51±22.46, t=-2.57, P=0.012). According to risk stratification of GRACE discharge score, the patients were divided into low-risk (≤88) group (n=6 902), moderate-risk (89-118) (n=2 988) and high-risk (>118) (n=343) groups. As compared to the low-risk group, CTE risk in moderate- and high-risk groups was 1.59 times (HR 1.59, 95%CI 1.01-2.52, P=0.046) and 3.89 times higher (HR 3.89, 95%CI 1.98-7.65, P<0.001), respectively. Further analysis showed that the GRACE score had predictive value in the total cohort for CTE (area under the receiver operating characteristic (AUROC) 0.576, 95%CI 0.512-0.640, P=0.012) and in the acute coronary syndromes(ACS) subgroup for CTE: (AUROC 0.594, 95%CI 0.509-0.680, P=0.019), but not in the non-ACS subgroup: (AUROC 0.561, 95%CI 0.466-0.657, P=0.187).@*Conclusion@#GRACE discharge score can predict the long-term out-of-hospital CTE in patients undergoing PCI with drug-eluting stents and treated with DAPT, and patients can be stratified into the low-, moderate- and high-risk groups of CTE by the GRACE discharge score.

Prognostic Value of TIMI and GRACE Risk Scores for In-hospital Mortality in Chinese Patients With ST-segment Elevation Myocardial Infarction / 中国循环杂志

Objectives:The purpose of this study was to evaluate the prognostic value of the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores for in-hospital mortality in Chinese ST-segment elevation myocardial infarction (STEMI) patients. Methods:Present data are obtained from the prospective, multicenter Chinese AMI (CAMI) registry, 107 hospitals from 31 provinces, municipalities or autonomous districts in China took part in this study. From January 2013 to September 2014, 17886 consecutive ST-segment elevation myocardial infarction patients admitted to these 107 hospitals were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value on the primary endpoint (in-hospital mortality) was evaluated. Results:Mean age of this patient cohort was (61.9±12.4)years, 76.5% (n=13685) patients were males. The in-hospital mortality was 6.4%(n=1 153)and the median length of hospital stay was 10.0 days. The incidence of cardiac arrest at admission were 4.3% (n=764). Coronary reperfusion therapy including fibrinolytic therapy(n=1782), primary percutaneous coronary intervention (n=7763) and emergent coronary artery bypass grafting (n=10) were applied to 9555 (53.4%) patients and the median of time to reperfusion was 300.0 minutes. The predictive accuracy of TIMI and GRACE for in-hospital mortality was similar:TIMI risk score (AUC) [area under the curve:0.7956; 95% confidence interval (95%CI:0.7822~0.8090)] and GRACE risk score (AUC:0.8096; 95%CI:0.7963~0.8230). Conclusions:The TIMI and GRACE risk score demonstrate similar predictive accuracy for in-hospital mortality and there are some disadvantages in risk stratification by these two risk scores for Chinese STEMI patients.

Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease

OBJECTIVE: Fibroblast growth factor (FGF) 21 is a recently established therapeutic target for treating metabolic syndromes, which include potential precursors to cardiovascular disease, suggesting a link between FGF21 and atherosclerosis. However, the association between serum FGF21 concentrations and coronary artery disease remain controversial. The aim of this study is to evaluate the association between circulating FGF21 concentrations and coronary artery lesions and clinical severity. METHODS: We enrolled 137 subjects who underwent coronary angiography, due to suspected acute coronary syndrome (ACS), from December 2009 to July 2012. Serum FGF21 levels were measured. Coronary artery lesions and clinical severities of the subjects were evaluated using the SYNergy between percutaneous coronary intervention with (paclitaxel-eluting) TAXus stent and cardiac surgery (SYNTAX) and Global Registry of Acute Coronary Events (GRACE) scoring system, respectively. RESULTS: After adjusting for established cardiovascular disease risk factors, including age, body mass index, total cholesterol, and low-density lipoprotein cholesterol, patients with coronary artery lesions (n=112 men) had significantly higher levels of FGF21 than individuals without such lesions (n=25; men) (377.1±20.1 pg/mL vs. 267.1±43.5 pg/mL; p=0.026). However, no correlations were found between serum levels of FGF21 and either the calculated STNTAX score (r=0.117; p=0.176) or GRACE risk score, which is a risk prediction tool applicable for ACS subjects (r=0.113; p=0.193). CONCLUSION: Although serum levels of FGF21 were higher in individuals with coronary lesions than in those without such lesions, FGF21 levels were not associated with angiographic severity.

Effect of GRACE Scores on Prediction of 30-day Cardiovascular Adverse Events in Patients with Acute Chest Pain / 中山大学学报(医学科学版)

[Objective]To investigate the effect of GRACE scores on prediction of 30-day cardiovascular adverse events in acute chest pain patients.[Methods]A prospective,observational analysis was conducted in the patients with acute chest pain in Emergency Department(ED)from January 1,2016 through April 1,2016.Data including characteris-tics and GRACE scores were collected.All causes leading to MACE were followed up at 30th day after the onset of acute chest pain.[Results]Among a total of 209 patients presenting with acute chest pain enrolled in this study,110 were male (52.63%)and 99 were female(47.37%).The range of age was 20-98years old,and mean age was(65.28±16.85)years old.During follow-up period,12 patients had MACE,2 patients died in ED,3 patients died in hospital,6 patients died out of hospital,and 1 person was diagnosed with myocardial infarction. When compared with non-MACE group,factors including age,BMI,hospitalized patient number,and number of patients admitted in CCU as well as GRACE scores, were significantly higher in MACE group(P<0.05). The predictive ROC curve area of GRACE scores in 30-day MACE was 0.819(0.735 to 0.902). The optimal sensitivity and specificity were 0.92 and 0.65,respectively. The probability of 30-day cardiovascular adverse events in various GRACE score risk stratification was 0.95%(low-risk),6.67%(medi-um-risk),and 18.92%(high-risk),respectively.[Conclusion]The GRACE score was a useful predictor to the occur-rence of 30-day cardiovascular adverse events in acute chest pain patients.

Lacan e o Deus-infinito de Pascal: considerações sobre a aposta pascaliana e o início de uma análise / Lacan and the God-infinite of Pascal: considerations about Pascal's wager and the beginning of a psychoanalysis treatment / Lacan y el Dios-infinito de Pascal: consideraciones sobre la apuesta de Pascal y el inicio de un análisis

O artigo tem como objetivo analisar a utilização que Jaques Lacan faz de um ponto específico da obra de Blaise Pascal, relacionado à aposta em um Deus-infinito. Lacan complementa o estudo da aposta pascaliana com uma referência à graça religiosa como momento inaugural de abertura ao infinito. A partir dessas considerações, sustenta-se a hipótese de que a aposta de Pascal pode ser aproximada à operação necessária para o início de uma análise. A aposta de Pascal coloca em jogo o infinito. Com a ajuda do filósofo Alain Badiou, tentaremos demonstrar que Lacan parte da mesma ideia ao considerar que não há abertura ao inconsciente - correlativa ao início de uma análise - sem alguma dimensão de infinitude

The article aims to analyze the use of a certain point in the work of Blaise Pascal, according to Jacques Lacan's, specifically about the wager on a God-infinite. Lacan complements the study of the Pascal's wager referring to the concept of the religious grace as the inaugural moment of opening to the infinite. From these considerations, the supported hypothesis is that Pascal's wager approaches the course necessary to the beginning of the psychoanalysis treatment. Pascal's wager puts infinite at stake. With the help of the philosopher Alain Badiou, we will try to demonstrate that Lacan shares the same idea when he considers that there is no opening to the unconscious - correlative to the beginning of an analysis - without some dimension of infinity

El artículo tiene como objetivo analizar la utilización que Jaques Lacan hace de un punto específico de la obra de Blaise Pascal, relacionada con apostar en un Dios-infinito. Lacan complementa el estudio de la apuesta de Pascal con una referencia a la gracia religiosa como momento inaugural de apertura al infinito. A partir de estas consideraciones se apoya la hipótesis de que la apuesta de Pascal se aproxima a la operación requerida para iniciar un análisis. La apuesta de Pascal pone en juego el infinito. Con la ayuda del filósofo Alain Badiou, trataremos de demostrar que Lacan parte de la misma idea al considerar que no hay apertura al inconsciente - correlativo al comienzo de un análisis- sin alguna dimensión de infinidad

FIB and D-D with GRACE Risk Score to Predict the Risk of Acute Coronary Syndrome / 现代检验医学杂志

Objective To investigate FIB and D-D with GRACE risk score to predict the risk of acute coronary syndrome (ACS)during hospitalization.Methods Plasma FIB,D-D and GRACE risk score were measured in 90 patients with ACS and 23 healthy controls,the number of coronary artery lesions of ACS patients also was obtained.Results The results of FIB,D-D levels and GRACE risk score in ACS group were 2.77±0.79 g/L,1.67±2.13 mg/L,147.19±32.50,respective-ly.Compared to controls,FIB,D-D and GRACE risk score in ACS group were significantly increased (t=6.256,6.465, 10.317,all P<0.001).There were significant differences in plasma D-D and FIB levels in different risk stratification (F=18.475,9.426,all P<0.001).FIB (r=0.485,P<0.000 1)and D-D (r=0.357,P<0.000 6)levels were found positively related with GRACE risk score.Conclusion Pasma FIB ,D-D levels and GRACE risk score were increased in ACS group. FIB and D-D can be used as indicators to predict the risk stratification for ACS patients,and D-D was better than FIB.

Value of hs-TnI combined with GRACE2 .0 score in predicting short term death risk in patients with ACS / 重庆医学

Objective To evaluate the value of high sensitive troponin I (hs-TnI) combined with the Global Registry of A-cute Coronary Events (GRACE) 2 .0 score in the prediction of death risk in the patients with acute coronary syndrome (ACS) . Methods The hs-TnI levels and GRACE2 .0 scores at admission in 347 ACS patients treated in the hospital from December 2015 to December 2016 were retrospectively analyzed .The follow up was performed for observing the effect of hs-TnI level and GRACE2 . 0 score on the short term (30 d) mortality rate of cardiovascular diseases .And the Kapian-Meier survival curve analysis was also used to analyze the effects of hs-TnI level and GRACE2 .0 score on the short term mortality rate of cardiovascular diseases .Results In this study ,the average value of hs-TnI level in the death group was (7 .5 ± 5 .6)μg/L ,which was significantly higher than (1 .2 ± 2 .9)μg/L in the survival group (P<0 .01) .The short term cardiovascular morality rate in ACS patients was positively cor-related with the hs-TnI level (P<0 .01) .The effect of hs-TnI level on short term cardiovascular morality rate in ACS patients was analyzed by the Kapian-Meier survival curve ,the patients with hs-TnI >0 .014 μg/L had significantly poor short term prognosis (Log rank 62 .81 ,P<0 .01);the GRACE2 .0 score showed positive correlation with the 30 d cardiovascular morality in ACS pa-tients(P<0 .01) ,the short term survival rate in the patients with extremely high risk ACS was significantly decreased (Log rank 116.56,P<0.001).Buttheareaunderthesurvivalcurve(AUC)ofhs-TnIwas0.079(95% CI:0.75-0.83,P<0.01),andAUCof GRACE2 .0 score was 0 .81(95% CI:0 .79-0 .84 ,P<0 .01) .In the comparison between them ,the predictive value of GRACE2 .0 risk score was slightly higher than that of hs-TnI .Therefore ,the combination of hs-TnI and GRACE risk score could increase the value for predicting recent cardiovascular morality in ACS patients [AUC=0 .84(0 .81-0 .91)] .Conclusion hs-TnI combined with GRACE2 .0 score has an important prediction value in short term cardiovascular death risk in ACS patients .

GRACE Score on Prognosis of ST-segment Elevation Myocardial Infarction in Patients Elder Than 75 Years With Primary Percutaneous Coronary Intervention / 中国循环杂志

Objective: To explore GRACE (global registry of acute coronary events)score on short term prognosis of ST-segment elevation myocardial infarction (STEMI)in patients elder than 75 years with primary percutaneous coronary intervention(PCI). Methods: A total of 104 STEMI patients elder than 75 years with primary PCI in our hospital from 2011-11 to 2014-01 were studied. Based on GRACEscore at admission, the patients were divided into 2 groups: Lower/mid risk group, n=72 patients with GRACEscore at 112-154 (136.5±10.6) and High risk group, n=32 patients with GRACE score at 155-202(167.8±12.3). The baseline condition and outcomes were compared between 2 groups and the primary endpoint was 1 year mortality. Predictive value of GRACEscore on 1 year mortality was evaluated by ROC curve, the relationships between Lower/mid risk group, High risk group and clinical outcomes were assessed by log-ranksurvive curve andunivariate Cox regression analysis. Results: The area under ROC curve for GRACEscore predicting 1 year mortality was 0.788 with the sensitivity at 70.0%and specificity at 84.0 %.Univariate Cox regression analysis indicated that compared with Lower/mid risk group, High risk group had the higher risk of 1-year death (HR=5.75, 95% CI 1.486-22.256, P=0.0113); log-rank survive curve presented that High risk group had the higher 1 year mortality (21.9% vs 4.2%, P=0.0039). Conclusion: GRACE score may further distinguish the lower/mid risk and high risk populations in elder STEMI patients; it may also predict 1 year clinical prognosis.

Application Value of Plasma Lipoprotein-associated Phospholipase A2 Level and AT- Ⅲ Activity on Risk Stratification and Nearby Risk Assessment in Patients With Non-ST Segment Elevation Acute Coronary Syndrome / 中国循环杂志

Objective: To explore the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, antithrombinⅢ (AT-Ⅲ ) activity and global registry of acute coronary events (GRACE) score in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS); to analyze the predictive value of Lp-PLA2, AT- Ⅲ on risk stratification and nearby risk assessment in NSTE-ACS patients. Methods: Our research included in 2 groups: NSTE-ACS group, n=260 patients with confirmed diagnosis and regular treatment; Control group, n=50 in-hospital patients with coronary angiography excluded coronary artery disease (CAD).plasma level of Lp-PLA2 and AT-Ⅲ activity were examined in the next morning of admission. GRACE score was calculated in NSTE-ACS patients and based on GRACE score, NSTE-ACS group was further divided into 3 subgroups as Low risk subgroup, GRACE score≤108, n=121, Middle risk subgroup, GRACE score (109-140), n=73 and High risk subgroup, GRACE score>140, n=66. The relationships between Lp-PLA2 level, AT-Ⅲ activity and GRACE score were evaluated and the occurrence of major adverse cardiovascular events (MACE) was recorded within 3 months of discharge. Results: ① Compared with Control group, NSTE-ACS group had increased Lp-PLA2 level, P<0.05 and decreased AT-Ⅲ activity, P<0.01. ② In NSTE-ACS group, Lp-PLA2 levels were elevating from Low risk subgroup to Middle risk subgroup and to High risk subgroup accordingly, all P<0.01; compared with Low risk and Middle risk subgroups, High risk subgroup showed decreased AT-Ⅲ activity, P<0.01 and P<0.05; while AT-Ⅲ activity was similar between Low risk and Middle risk subgroups, P>0.05. ③Partial correlation analysis presented that GRACE score was positively related to Lp-PLA2 (r=0.641, P=0.000) and negatively related AT-III (r=-0.179, P=0.006). ④ The area under ROC curve for MACE occurrence in GRACE score was 0.811, in Lp-PLA2 was 0.862 and in AT- Ⅲ was 0.631, all P<0.01; multivariate Logistic regression analysis indicated that Lp-PLA2, GRACE score and HDL-C were the independent predictors for nearby MACE occurrence in NSTE-ACS patients. Conclusion: Blood Lp-PLA2 level and AT-Ⅲ activity were important for risk stratification in NSTE-ACS patients;AT- Ⅲ had less value than Lp-PLA2 and GRACE score for nearby risk assessment.

Predictive Value of Lipoprotein-associated Phospholipase A2 in Patients With Acute Coronary Syndrome / 中国循环杂志

Objective: To explore the risk predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) on acute coronary syndrome(ACS) and to study the relationship between Lp-PLA2 and the severity of coronary stenosis in ACS patients. Methods:A total of 155 ACS patients admitted in our hospital were enrolled. The patient were divided into 2 groups:AMI (acute myocardial infarction) group, n=49 and UA (unstable angina)group, n=106; in addition, there was a Control group, n=44 subjects with normal coronary angiography (CAG).Blood levels of Lp-PLA2 were examined, CAG was conducted and GRACE score, SYNTAX score,Gensini score were calculated. Based on Grace score, ACS patients were divided into 3 subgroups: Low risk subgroup, Grace score≤108, Mid risk subgroup,Grace score 109-140 and High risk subgroup,Grace score≥140.The above parameters were comparedamong different groups. Results: Compared with UA group and Control group, AMI group had increased blood level of Lp-PLA2, P<0.05. Compared with Low risk subgroup, High risk subgroup had much higher Lp-PLA2, P<0.05. Correlation analysis showed that Lp-PLA2 level was positively related to Gracescore (r=0.301, P<0.001). By SYNTAX score and Gensini score evaluation,Lp-PLA2 levels were similar among different subgroups. Conclusion:Blood level of Lp-PLA2 had certain risk predictive value in ACS patients; while it was not related to the severity of coronary stenosis.