دورية أكاديمية
Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes.
| العنوان: | Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes. |
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| المؤلفون: | Georgiopoulos G; Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.; Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Kraler S; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland., Mueller-Hennessen M; Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany., Delialis D; Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece., Mavraganis G; Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece., Sopova K; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.; Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom., Wenzl FA; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland., Räber L; Department of Cardiology, Swiss Heart Center, Inselspital Bern, Bern, Switzerland., Biener M; Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany., Stähli BE; Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland., Maneta E; Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece., Spray L; Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom., Iglesias JF; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Coelho-Lima J; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom., Tual-Chalot S; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom., Muller O; Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Mach F; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Frey N; Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany., Duerschmied D; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.; Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Langer HF; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.; Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Katus H; Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany., Roffi M; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Camici GG; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland., Mueller C; Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland., Giannitsis E; Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany., Spyridopoulos I; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.; Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom., Lüscher TF; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.; Royal Brompton and Harefield Hospitals and Imperial College and Kings College, London, United Kingdom., Stellos K; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.; Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom., Stamatelopoulos K; Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.; Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom. |
| المصدر: | JAMA cardiology [JAMA Cardiol] 2023 Oct 01; Vol. 8 (10), pp. 946-956. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101676033 Publication Model: Print Cited Medium: Internet ISSN: 2380-6591 (Electronic) NLM ISO Abbreviation: JAMA Cardiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Chicago, Illinois] : American Medical Association, [2016]- |
| مواضيع طبية MeSH: | Acute Coronary Syndrome*/blood , Acute Coronary Syndrome*/diagnosis , Acute Coronary Syndrome*/mortality , Acute Coronary Syndrome*/therapy , Risk Assessment* , ST Elevation Myocardial Infarction*/blood , ST Elevation Myocardial Infarction*/diagnosis , Troponin T*/blood, Female ; Humans ; Male ; Middle Aged ; Longitudinal Studies ; Registries ; Retrospective Studies ; Risk Factors ; Aged |
| مستخلص: | Importance: The Global Registry of Acute Coronary Events (GRACE) risk score, a guideline-recommended risk stratification tool for patients presenting with acute coronary syndromes (ACS), does not consider the extent of myocardial injury. Objective: To assess the incremental predictive value of a modified GRACE score incorporating high-sensitivity cardiac troponin (hs-cTn) T at presentation, a surrogate of the extent of myocardial injury. Design, Setting, and Participants: This retrospectively designed longitudinal cohort study examined 3 independent cohorts of 9803 patients with ACS enrolled from September 2009 to December 2017; 2 ACS derivation cohorts (Heidelberg ACS cohort and Newcastle STEMI cohort) and an ACS validation cohort (SPUM-ACS study). The Heidelberg ACS cohort included 2535 and the SPUM-ACS study 4288 consecutive patients presenting with a working diagnosis of ACS. The Newcastle STEMI cohort included 2980 consecutive patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Data were analyzed from March to June 2023. Exposures: In-hospital, 30-day, and 1-year mortality risk estimates derived from an updated risk score that incorporates continuous hs-cTn T at presentation (modified GRACE). Main Outcomes and Measures: The predictive value of continuous hs-cTn T and modified GRACE risk score compared with the original GRACE risk score. Study end points were all-cause mortality during hospitalization and at 30 days and 1 year after the index event. Results: Of 9450 included patients, 7313 (77.4%) were male, and the mean (SD) age at presentation was 64.2 (12.6) years. Using continuous rather than binary hs-cTn T conferred improved discrimination and reclassification compared with the original GRACE score (in-hospital mortality: area under the receiver operating characteristic curve [AUC], 0.835 vs 0.741; continuous net reclassification improvement [NRI], 0.208; 30-day mortality: AUC, 0.828 vs 0.740; NRI, 0.312; 1-year mortality: AUC, 0.785 vs 0.778; NRI, 0.078) in the derivation cohort. These findings were confirmed in the validation cohort. In the pooled population of 9450 patients, modified GRACE risk score showed superior performance compared with the original GRACE risk score in terms of reclassification and discrimination for in-hospital mortality end point (AUC, 0.878 vs 0.780; NRI, 0.097), 30-day mortality end point (AUC, 0.858 vs 0.771; NRI, 0.08), and 1-year mortality end point (AUC, 0.813 vs 0.797; NRI, 0.056). Conclusions and Relevance: In this study, using continuous rather than binary hs-cTn T at presentation, a proxy of the extent of myocardial injury, in the GRACE risk score improved the mortality risk prediction in patients with ACS. |
| التعليقات: | Erratum in: JAMA Cardiol. 2024 Jan 1;9(1):95. (PMID: 37938826) |
| معلومات مُعتمدة: | United Kingdom WT_ Wellcome Trust; PG/18/25/33587 United Kingdom BHF_ British Heart Foundation |
| المشرفين على المادة: | 0 (Troponin T) |
| تواريخ الأحداث: | Date Created: 20230830 Date Completed: 20231012 Latest Revision: 20240214 |
| رمز التحديث: | 20240214 |
| مُعرف محوري في PubMed: | PMC10469286 |
| DOI: | 10.1001/jamacardio.2023.2741 |
| PMID: | 37647046 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2380-6591 |
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| DOI: | 10.1001/jamacardio.2023.2741 |