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Published on: August 9, 2024
Point-of-care testing of cardiac autonomic function for risk assessment in patients with suspected acute coronary
C Eick1, M Duckheim1, P Groga-Bada1
1Medizinische Klinik III, Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
Insights
Point-of-care testing of cardiac autonomic function using deceleration capacity (DC) in patients with suspected acute coronary syndromes (ACS) significantly improves risk assessment. This method enhances the GRACE score, particularly for patients with lower risk scores.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Risk Stratification
Background:
- Impaired cardiac autonomic function is linked to adverse outcomes in acute coronary syndromes (ACS) but is not typically included in clinical risk models.
- This study investigates the utility of short-term deceleration capacity (DC) for risk assessment in suspected ACS patients.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of point-of-care testing of cardiac autonomic function using DC.
- To determine if DC improves risk stratification beyond the established GRACE score in patients with suspected ACS.
Main Methods:
- 1821 patients with suspected ACS in sinus rhythm were prospectively enrolled.
- Short-term DC was automatically assessed at hospital admission.
- The Global Registry of Acute Coronary Events (GRACE) score was used as a benchmark for risk prediction.
Main Results:
- Deceleration capacity (DC) was a significant predictor of both intrahospital/30-day mortality (AUC 0.784) and 180-day mortality (AUC 0.781).
- Integrating DC into the GRACE score significantly improved risk prediction for both primary and secondary endpoints (p < 0.01).
- DC stratification was particularly effective in patients with a GRACE score below 140.
Conclusions:
- Point-of-care testing of cardiac autonomic function via DC is feasible in patients with suspected ACS.
- DC testing enhances the risk assessment capabilities of the GRACE score in this patient population.
Background:
Impaired cardiac autonomic function has been linked to adverse outcomes in patients with acute coronary syndromes (ACS) but is not included in clinical risk models. This is the first study to investigate whether point-of-care testing of cardiac autonomic function by means of short-term deceleration capacity (DC) of heart rate improves risk assessment in patients with suspected ACS.
Methods:
1821 patients with suspected ACS were prospectively enrolled if they were older than 17 years and in sinus rhythm. Short-term DC was automatically assessed from monitor recordings at hospital admission. The Global Registry of Acute Coronary Events (GRACE) score was used as gold standard risk predictor. Primary endpoint was the composite of intrahospital and 30-day mortality. Secondary endpoint was 180-day mortality.
Results:
Of the 1,821 patients with suspected ACS, 28 (1.5%) and 60 (3.3%) reached the primary and secondary endpoints, respectively. DC was a highly significant predictor of both endpoints, yielding areas under the curve (AUC) of 0.784 (95% CI 0.714-0.854) and 0.781 (0.727-0.832) (p < 0.001 for both), respectively. Implementing DC into the GRACE-risk model leads to a significant increase of the C-statistics from 0.788 (0.703-0.874) to 0.825 (0.750-0.900; p < 0.01 for difference) and from 0.814 (0.759-0.864) to 0.851 (0.808-0.889; p < 0.01 for difference) for the primary and secondary endpoints, respectively. Stratification by dichotomized DC was especially powerful in patients with GRACE score <140.
Conclusions:
In patients with suspected ACS, point-of-care testing of cardiac autonomic function by means of DC is feasible and improves risk assessment by the GRACE score.
Clinical Trial Registration:
Clinicaltrials.gov NCT01486589.
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