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Kohar K, Sanjaya IS, Amirah S, Yumnanisha DA, Ambari AM. The potential of triglyceride-glucose index in improving the prediction of post-percutaneous coronary intervention clinical outcomes: a systematic review and meta-analysis. Acta Cardiol 2024; 79:557-565. [PMID: 38722072 DOI: 10.1080/00015385.2024.2349829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 09/03/2024]
Abstract
INTRODUCTION Despite percutaneous coronary intervention is the current preferred reperfusion modality, the incidence of major adverse cardiovascular events (MACE) is still high. Currently, GRACE score is used for predicting PCI outcomes. The TyG (triglyceride-glucose) index, a potential predictor based on insulin resistance of cardiovascular disease, has not been considered in the GRACE score. OBJECTIVE To assess the potential of the TyG index in predicting cardiovascular adverse clinical outcomes in patients undergoing PCI. METHOD Following PRISMA guidelines, the authors reviewed literature from five databases. We included studies investigating post-PCI outcomes based on the TyG index level. Effect size was estimated using RevMan to calculate pooled odds ratio and mean difference, and R software to perform diagnostic test accuracy. RESULTS Overall, 31,671 post-PCI patients with acute coronary syndrome were included in this study. A significant difference in TyG index was found between patients who experienced MACE and those who did not [MD: 0.3 (0.2-0.4), p < .05]. Higher TyG index was strongly correlated with higher MACE [OR: 2.01 (1.45-2.77), p < .05], especially revascularization [OR: 2.40 (1.72-3.36), p < .05], followed by myocardial infarction [OR: 1.80 (2.41-2.86), p < .05], death [OR: 1.36 (0.86-2.15), p = .19], and stroke [OR: 1.09 (0.79-1.50), p = .59]. Tyg Index showed 55% sensitivity, 60% specificity, and 0.612 accuracy. The addition of the TyG index to the GRACE scoring improved the predictive model's AUC (0.746 vs. 0.809). CONCLUSION This systematic review and meta-analysis comprises evidence-based results for the correlation of TyG index and post-PCI outcomes, demonstrating modest sensitivity, specificity, accuracy, and enhanced predictive value of GRACE score.
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Affiliation(s)
- Kelvin Kohar
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Shakira Amirah
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Ade Meidian Ambari
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Lopez-Rojas LM, Paredes Paucar CP, Rojas De La Cuba P, Yábar Galindo WG, Martos Salcedo JO, Custodio-Sánchez P. [Reply yo the letter to the editor : "Keeping an eye on the pharmacoinvasive strategy"]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e368. [PMID: 39015188 PMCID: PMC11247967 DOI: 10.47487/apcyccv.v5i2.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 07/18/2024]
Affiliation(s)
- L. Marco Lopez-Rojas
- Hospital Nacional Alberto Sabogal Sologuren - EsSalud. Lima, Perú.Hospital Nacional Alberto Sabogal Sologuren - EsSaludLimaPerú
| | - Cynthia Paola Paredes Paucar
- Hospital Germans Trias i Pujol, Unidad de Insuficiencia Cardiaca. Barcelona, España.Hospital Germans Trias i PujolUnidad de Insuficiencia CardiacaBarcelonaEspaña
| | - Paol Rojas De La Cuba
- Hospital Nacional Guillermo Almenara Irigoyen-EsSalud. Lima, Perú.Hospital Nacional Guillermo Almenara Irigoyen-EsSaludLimaPerú
| | - W. Germán Yábar Galindo
- Hospital Nacional Guillermo Almenara Irigoyen-EsSalud. Lima, Perú.Hospital Nacional Guillermo Almenara Irigoyen-EsSaludLimaPerú
| | - Jorge Orlando Martos Salcedo
- Hospital Regional Docente de Cajamarca-MINSA. Servicio de Cardiología. Cajamarca, Perú.Hospital Regional Docente de Cajamarca-MINSAServicio de CardiologíaCajamarcaPerú
| | - Piero Custodio-Sánchez
- Hospital Nacional Almanzor Aguinaga Asenjo - EsSalud. Unidad de cardiología intervencionista. Chiclayo, Perú.Hospital Nacional Almanzor Aguinaga Asenjo - EsSaludUnidad de cardiología intervencionistaChiclayoPerú
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Zhang K, Jiang Y, Zeng H, Zhu H. Application and risk prediction of thrombolytic therapy in cardio-cerebrovascular diseases: a review. Thromb J 2023; 21:90. [PMID: 37667349 PMCID: PMC10476453 DOI: 10.1186/s12959-023-00532-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
Cardiocerebrovascular diseases (CVDs) are the leading cause of death worldwide, consuming huge healthcare budget. For CVD patients, the prompt assessment and appropriate administration is the crux to save life and improve prognosis. Thrombolytic therapy, as a non-invasive approach to achieve recanalization, is the basic component of CVD treatment. Still, there are risks that limits its application. The objective of this review is to give an introduction on the utilization of thrombolytic therapy in cardiocerebrovascular blockage diseases, including coronary heart disease and ischemic stroke, and to review the development in risk assessment of thrombolytic therapy, comparing the performance of traditional scales and novel artificial intelligence-based risk assessment models.
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Affiliation(s)
- Kexin Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yao Jiang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Hongling Zhu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Yan J, Deng CJ, Wang SF, Aimaitijiang M, Wu TT, Zheng YY, Xie X, Ma YT. Predictive Value of the Modified GRACE Scoring System for All-Cause Mortality in Patients with Acute Myocardial Infarction. Rev Cardiovasc Med 2023; 24:161. [PMID: 39077519 PMCID: PMC11264122 DOI: 10.31083/j.rcm2406161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 07/31/2024] Open
Abstract
Background To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system. Methods We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital's electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 ± 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample t test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves. Results Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample t test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and β -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and β -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, p < 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, p < 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant (p < 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 > 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score. Conclusions The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system. Clinical Trial Registration NCT02737956.
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Affiliation(s)
- Ju Yan
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Chang-Jiang Deng
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Si-Fan Wang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Mikereyi Aimaitijiang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Ting-Ting Wu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Ying-Ying Zheng
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Xiang Xie
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
| | - Yi-Tong Ma
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China
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Chiang CY, Lin CF, Liu PH, Chen FC, Chiu IM, Cheng FJ. Clinical Validation of the Shock Index, Modified Shock Index, Delta Shock Index, and Shock Index-C for Emergency Department ST-Segment Elevation Myocardial Infarction. J Clin Med 2022; 11:jcm11195839. [PMID: 36233705 PMCID: PMC9573755 DOI: 10.3390/jcm11195839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background: ST-segment elevation myocardial infarction (STEMI) is a leading cause of death worldwide. A shock index (SI), modified SI (MSI), delta-SI, and shock index-C (SIC) are known predictors of STEMI. This retrospective cohort study was designed to compare the predictive value of the SI, MSI, delta-SI, and SIC with thrombolysis in myocardial infarction (TIMI) risk scales. Method: Patients > 20 years old with STEMI who underwent percutaneous coronary intervention (PCI) were included. Receiver operating characteristic (ROC) curve analysis with the Youden index was performed to calculate the optimal cutoff values for these predictors. Results: Overall, 1552 adult STEMI cases were analyzed. The thresholds for the emergency department (ED) SI, MSI, SIC, and TIMI risk scales for in-hospital mortality were 0.75, 0.97, 21.00, and 5.5, respectively. Accordingly, ED SIC had better predictive power than the ED SI and ED MSI. The predictive power was relatively higher than TIMI risk scales, but the difference did not achieve statistical significance. After adjusting for confounding factors, the ED SI > 0.75, MSI > 0.97, SIC > 21.0, and TIMI risk scales > 5.5 were statistically and significantly associated with in-hospital mortality of STEMI. Compared with the ED SI and MSI, SIC (>21.0) had better sensitivity (67.2%, 95% CI, 58.6−75.9%), specificity (83.5%, 95% CI, 81.6−85.4%), PPV (24.8%, 95% CI, 20.2−29.6%), and NPV (96.9%, 95% CI, 96.0−97.9%) for in-hospital mortality of STEMI. Conclusions: SIC had better discrimination ability than the SI, MSI, and delta-SI. Compared with the TIMI risk scales, the ACU value of SIC was still higher. Therefore, SIC might be a convenient and rapid tool for predicting the outcome of STEMI.
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Affiliation(s)
- Charng-Yen Chiang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Chien-Fu Lin
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Fu-Cheng Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
- Correspondence: ; Tel.: +886-975-056-646
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Ismail SR, Khalil MKN, Mohamad MSF, Azhar Shah S. Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction. Front Cardiovasc Med 2022; 9:921044. [PMID: 35958391 PMCID: PMC9360484 DOI: 10.3389/fcvm.2022.921044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The cultural and genetic diversity of the Southeast Asian population has contributed to distinct cardiovascular disease risks, incidence, and prognosis compared to the Western population, thereby raising concerns about the accuracy of predicted risks of existing prognostic models. Objectives We aimed to evaluate the predictive performances of validated, recalibrated, and developed prognostic risk prediction tools used in the Southeast Asian population with acute myocardial infarction (AMI) events for secondary events Methods We searched MEDLINE and Cochrane Central databases until March 2022. We included prospective and retrospective cohort studies that exclusively evaluated populations in the Southeast Asian region with a confirmed diagnosis of an AMI event and evaluated for risk of secondary events such as mortality, recurrent AMI, and heart failure admission. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review. Results We included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. Both short- and long-term outcomes were assessed. Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. The pooled estimate of the C-statistic in the Southeast Asian population for GRACE risk score is 0.83 (95%CI 0.72–0.90, n = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772–0.83, n = 5 validations). Recalibrated and new models demonstrated marginal improvements in discriminative values. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies. Conclusion Both TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, with the limited strength of evidence, these results should be interpreted with caution. Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486.
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Affiliation(s)
- Sophia Rasheeqa Ismail
- Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Muhamad Khairul Nazrin Khalil
- Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
| | | | - Shamsul Azhar Shah
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
- *Correspondence: Shamsul Azhar Shah
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Boyraz B, Ibisoglu E, Aslan B. The prognostic value of the nutritional prognostic index (NPI) and controlling nutritional status (CONUT) scoring systems in non-ST elevated myocardial infarction patients over 65 years of age. Aging Clin Exp Res 2022; 34:555-562. [DOI: 10.1007/s40520-021-02039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
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Opincariu D, Rodean I, Rat N, Hodas R, Benedek I, Benedek T. Systemic Vulnerability, as Expressed by I-CAM and MMP-9 at Presentation, Predicts One Year Outcomes in Patients with Acute Myocardial Infarction-Insights from the VIP Clinical Study. J Clin Med 2021; 10:jcm10153435. [PMID: 34362217 PMCID: PMC8347806 DOI: 10.3390/jcm10153435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: The prediction of recurrent events after acute myocardial infarction (AMI) does not sufficiently integrate systemic inflammation, coronary morphology or ventricular function in prediction algorithms. We aimed to evaluate the accuracy of inflammatory biomarkers, in association with angiographical and echocardiographic parameters, in predicting 1-year MACE after revascularized AMI. (2) Methods: This is an extension of a biomarker sub-study of the VIP trial (NCT03606330), in which 225 AMI patients underwent analysis of systemic vulnerability and were followed for 1 year. Hs-CRP, MMP-9, IL-6, I-CAM, V-CAM and E-selectin were determined at 1 h after revascularization. The primary end-point was the 1-year MACE rate. (3) Results: The MACE rate was 24.8% (n = 56). There were no significant differences between groups in regard to IL-6, V-CAM and E-selectin. The following inflammatory markers were significantly higher in MACE patients: hs-CRP (11.1 ± 13.8 vs. 5.1 ± 4.4 mg/L, p = 0.03), I-CAM (452 ± 283 vs. 220.5 ± 104.6, p = 0.0003) and MMP-9 (2255 ± 1226 vs. 1099 ± 706.1 ng/mL p = 0.0001). The most powerful predictor for MACE was MMP-9 of >1155 ng/mL (AUC-0.786, p < 0.001) even after adjustments for diabetes, LVEF, acute phase complications and other inflammatory biomarkers. For STEMI, the most powerful predictors for MACE included I-CAM > 239.7 ng/mL, V-CAM > 877.9 ng/mL and MMP-9 > 1393 ng/mL. (4) Conclusions: High levels of I-CAM and MMP-9 were the most powerful predictors for recurrent events after AMI for the overall study population. For STEMI subjects, the most important predictors included increased levels of I-CAM, V-CAM and MMP-9, while none of the analyzed parameters had proven to be predictive. Inflammatory biomarkers assayed during the acute phase of AMI presented a more powerful predictive capacity for MACE than the LVEF.
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Affiliation(s)
- Diana Opincariu
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
- Cardiomed Medical Center, 22 December 1989 Street, No. 76, 540124 Târgu Mureș, Romania
- Correspondence: or (D.O.); or (R.H.); Tel.: +40-756-787-587 (D.O.); +40-742-385-600 (R.H.)
| | - Ioana Rodean
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
| | - Nora Rat
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
- Cardiomed Medical Center, 22 December 1989 Street, No. 76, 540124 Târgu Mureș, Romania
| | - Roxana Hodas
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
- Correspondence: or (D.O.); or (R.H.); Tel.: +40-756-787-587 (D.O.); +40-742-385-600 (R.H.)
| | - Imre Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
- Cardiomed Medical Center, 22 December 1989 Street, No. 76, 540124 Târgu Mureș, Romania
| | - Theodora Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540142 Târgu Mureș, Romania; (I.R.); (N.R.); (I.B.); (T.B.)
- Cardiomed Medical Center, 22 December 1989 Street, No. 76, 540124 Târgu Mureș, Romania
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Sofidis G, Otountzidis N, Stalikas N, Karagiannidis E, Papazoglou AS, Moysidis DV, Panteris E, Deda O, Kartas A, Zegkos T, Daskalaki P, Theodoridou N, Stefanopoulos L, Karvounis H, Gika H, Theodoridis G, Sianos G. Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome. J Clin Med 2021; 10:2210. [PMID: 34065227 PMCID: PMC8160761 DOI: 10.3390/jcm10102210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE score in predicting the extent of CAD. A total of 539 patients with ACS undergoing coronary angiography were included in this analysis. The patients were classified into those with a SYNTAX score < 33 and a SYNTAX score ≥ 33. Spearman's correlation and receiver operator characteristic analysis were conducted to investigate the role of the GRACE score as a predictor of the SYNTAX score. There was a significantly positive correlation between the SYNTAX and the GRACE scores (r = 0.32, p < 0.001). The GRACE score predicted severe CAD (SYNTAX ≥ 33) moderately well (the area under the curve was 0.595 (0.522-0.667)). A GRACE score of 126 was documented as the optimal cut-off for the prediction of a SYNTAX score ≥ 33 (sensitivity = 53.5% and specificity = 66%). Therefore, our study reports a significantly positive correlation between the GRACE and the SYNTAX score in patients with ACS. Notably, NSTEMI patients with a high-risk coronary anatomy have higher calculated GRACE scores. A multidisciplinary approach by a heart team could possibly alter the therapeutic approach and management in patients presenting with ACS and a high calculated GRACE score.
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Affiliation(s)
- Georgios Sofidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Nikolaos Otountzidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Eleftherios Panteris
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (O.D.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece;
| | - Olga Deda
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (O.D.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece;
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Paraskevi Daskalaki
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Niki Theodoridou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
| | - Helen Gika
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (O.D.); (H.G.)
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece;
| | - Georgios Theodoridis
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, B1.4, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001 Thessaloniki, Greece;
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (G.S.); (N.O.); (N.S.); (E.K.); (A.S.P.); (D.V.M.); (A.K.); (T.Z.); (P.D.); (N.T.); (H.K.)
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