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Published on: May 28, 2019
Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction: A
Insights
The Glasgow Prognostic Score (GPS) effectively predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). A higher GPS indicates a significantly increased risk of both in-hospital and long-term adverse outcomes.
Area of Science:
- Cardiology
- Oncology
- Biomarkers
Background:
- The Glasgow Prognostic Score (GPS), an inflammation-based score using C-reactive protein and albumin, is a known mortality predictor in various cancers.
- Its utility in acute cardiovascular events like ST-segment elevation myocardial infarction (STEMI) remains less explored.
Purpose of the Study:
- To investigate the association between the GPS and mortality in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI).
- To assess the GPS's potential as a prognostic tool in this specific patient population.
Main Methods:
- Prospective enrollment of 406 consecutive STEMI patients undergoing pPCI at an emergency department.
- Calculation of GPS (0, 1, or 2) upon admission.
- Kaplan-Meier survival analysis and multivariable Cox regression to assess GPS and mortality link.
Main Results:
- Higher GPS scores were significantly associated with increased in-hospital, follow-up, and cumulative mortality.
- Patients with GPS 1 and 2 had Hazard Ratios (HR) of 2.068 and 8.305, respectively, for all-cause mortality compared to GPS 0.
- Subgroup analyses confirmed GPS as a consistent predictor of cumulative mortality risk.
Conclusions:
- The GPS is a valuable tool for risk stratification in STEMI patients undergoing pPCI.
- Admission GPS can help identify patients at higher risk of adverse outcomes, guiding clinical management.
Abstract:
The inflammation-based Glasgow Prognostic Score (GPS), which involves C-reactive protein and serum albumin levels, has been reported to be a strong independent predictor of mortality in many cancers. This study aimed to investigate whether the GPS is associated with mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).In this study, 406 consecutive patients with STEMI at our emergency department (ED) who were undergoing pPCI were prospectively enrolled and assigned a GPS of 0, 1, or 2. Kaplan-Meier survival and multivariable Cox regression analyses were used to evaluate the associations between the GPS and long-term mortality.Twenty-three patients (5.7%) died at the hospital, and 37 (9.7%) died during follow-up (14.4 [9.3-17.6] months). Compared with patients with a lower GPS, those with a higher GPS had significantly higher in-hospital mortality (GPS = 0 vs GPS = 1 vs GPS = 2: 3.3% vs 6.3% vs 28.0%, P < .001), follow-up mortality (4.6% vs 14.3% vs 55.6%, P < .001), and cumulative mortality (9.6% vs 21.1% vs 71.1%, P < .001). Multivariable Cox regression analysis revealed that in patients with a GPS of 1 and 2 (versus 0), the multivariable adjusted hazard ratios (HR) for all-cause mortality were 2.068 (95% CI: 1.082-3.951, P = .028) and 8.305 (95% CI: 4.017-17.171, P < .001), respectively, after controlling for all of the confounding factors. Subgroup analysis showed that a higher GPS was associated with an increased risk of cumulative mortality in the different subgroups.The GPS on admission may be useful for stratifying the risk of adverse outcomes in patients with STEMI undergoing pPCI in the ED.
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