Biomarkers enhance the long-term predictive ability of the KAMIR risk score in Chinese patients with ST-elevation myocardial infarction / 中华医学杂志(英文版)

ABSTRACT

BACKGROUND@#The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines. But it has inherent defects. The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.@*METHODS@#A total of 1093 consecutive STEMI patients were included and followed up 48.2 months. Homocysteine, hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected. The KAMIR score and the GRACE score were calculated. The performance between the KAMIR and the GRACE was compared. The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.@*RESULTS@#The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death AUC = 0.802 vs. 0.721, P < 0.001; major adverse cardiovascular events (MACE) AUC = 0.683 vs. 0.656, P < 0.001). It showed that the biomarkers could independently predict death [homocysteine HR = 1.019 (1.015-1.024), P < 0.001; hs-CRP HR = 1.052 (1.000-1.104), P = 0.018; NT-pro BNP HR = 1.142 (1.004-1.280), P = 0.021] and MACE [homocysteine HR = 1.019 (1.015-1.024), P < 0.001; hs-CRP HR = 1.012 (1.003-1.021), P = 0.020; NT-pro BNP HR = 1.136 (1.104-1.168), P = 0.006]. When they were used in combination with the KAMIR, the area under the ROC curve (AUC) significantly increased for death [homocysteine AUC = 0.802 vs. 0.890, Z = 5.982, P < 0.001; hs-CRP AUC = 0.802 vs. 0.873, Z = 3.721, P < 0.001; NT-pro BNP AUC = 0.802 vs. 0.871, Z = 2.187, P = 0.047; homocysteine, hs-CRP and NT-pro BNP AUC = 0.802 vs. 0.940, Z = 6.177, P < 0.001] and MACE [homocysteine AUC = 0.683 vs. 0.771, Z = 6.818, P < 0.001; hs-CRP AUC = 0.683 vs. 0.712, Z = 2.022, P = 0.031; NT-pro BNP AUC = 0.683 vs. 0.720, Z = 2.974, P = 0.003; homocysteine, hs-CRP and NT-pro BNP AUC = 0.683 vs. 0.789, Z = 6.900, P < 0.001].@*CONCLUSION@#The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients. A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.