RESUMO
【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.
RESUMO
Objective To evaluate the correlation between plasma high sensitivity C reactive protein (hs-CRP) level and global registry of acute coronary events (GRACE) scores,and its predictive value for long-term (5 years) cardiovascular events in middle-aged and elderly patients with acute coronary syndrome (ACS).Methods 138 middle aged and elderly patients with ACS were divided into three groups according to GRACE scores:low risk group,middle risk group,high risk group.And based on quartiles of hs-CRP levels,subjects were segregated into 4 groups (Q1 to Q4).All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded.Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification (hs-CRP low risk group,0.09 ± 0.22 ; middle risk group,0.21 ± 0.04 ;high risk group,0.43±0.23,P＜0.001).Meantime,GRACE risk scores were gradually increased along with increasing hs-CRP levels from Q1 to Q4 (Q1:133.0 ± 43.6; Q2:161.9 ± 60.2; Q3:169.3±52.6; Q4:188.4±47.5; all P＜0.001).Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores (r=0.576,P＜0.001).During a follow-up period of about 5 years,96 cardiovascular events were recorded.Receiver operating characteristic(ROC) curve analysis showed that area under the ROC curve (AUC) of hs-CRP was 0.821 (95 ％CI:0.749-0.892,P＜0.001) and AUC of GRACE risk score was 0.869 (95％CI:0.801 0.938,P＜0.001) in the evaluation of the long-term risk of incident cardiovascular events.The differences in prediction of long-term cardiovascular events in middle-aged and elderly patients with ACS were not significant (P =0.237) between GRACE risk score and hs CRP level.Conclusions Plasma hs-CRP level is positively associated with GRACE score.Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.