A Combination of Heart Rate-Corrected QT Interval and GRACE Risk Score Better Predict Early Mortality in Patients
Saadet Demirtaş İnci1, Mustafa Agah Tekindal2, Meltem Altınsoy1
1Department of Cardiology, Health Sciences University, Dışkapı Yıldırım Beyazıd Training and Research Hospital, Ankara, Turkey.
Insights
Adding a prolonged heart rate-corrected QT interval to the Global Registry of Acute Coronary Events risk score improves early mortality prediction in non-ST segment elevation acute coronary syndrome patients. This combination offers enhanced prognostic value for clinical decision-making.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Electrocardiography
Background:
- Non-ST segment elevation acute coronary syndrome (NSTE-ACS) poses a significant risk of early mortality.
- Existing risk scores, like the Global Registry of Acute Coronary Events (GRACE), aid in stratifying patient risk.
- The prognostic role of electrocardiographic parameters, such as the corrected QT interval (QTc), in NSTE-ACS requires further investigation.
Purpose of the Study:
- To determine if incorporating QTc prolongation into the GRACE risk score enhances its predictive accuracy for early mortality in NSTE-ACS patients.
- To evaluate the independent and combined predictive values of QTc interval and GRACE score for early mortality.
Main Methods:
- A retrospective analysis of 283 NSTE-ACS patients was conducted.
- Electrocardiograms were analyzed to measure the QT interval using the tangent method.
- Early mortality was defined as all-cause death during hospitalization or within 30 days post-discharge.
Main Results:
- Prolonged QTc interval was observed in 59 patients, with a significantly higher mortality rate (16.9%, P < .001).
- Both GRACE score (OR: 1.032) and QTc interval (OR: 1.026) independently predicted early mortality.
- The combined model of GRACE score and QTc interval demonstrated improved predictive accuracy (AUC: 0.808) compared to either factor alone (AUC: 0.780 for GRACE, 0.769 for QTc).
Conclusions:
- Prolonged QTc interval and the GRACE risk score are independent predictors of early mortality in NSTE-ACS.
- The combination of QTc interval and GRACE score offers superior predictive value for early mortality in this patient cohort.
- This finding suggests that QTc interval assessment can augment risk stratification strategies for NSTE-ACS patients.
Objective:
This study aimed to evaluate whether the addition of heart rate-corrected QT inter- val prolongation to the Global Registry of Acute Coronary Events risk score improves the pre- dictive value for early mortality in patients with non-ST segment elevation acute coronary syndrome.
Methods:
We retrospectively screened our database for consecutive non-ST-segment eleva- tion acute coronary syndrome patients between January 2017 and July 2019. The demographic and clinical parameters were acquired via chart review. All electrocardiograms were reviewed by 2 physicians. QT interval was measured using the tangent method. Early mortality was defined as all-cause death observed during the hospital stay or within 30 days after discharge.
Results:
The final study population consisted of 283 patients, there were 17 early deaths. Ten of 59 patients with prolonged corrected QT intervals died (16.9%, P < .001). Both the Global Registry of Acute Coronary Events risk score (odds ratio: 1.032; 95% CI: 1.012-1.053; P = .002) and corrected QT interval (odds ratio: 1.026; 95% CI: 1.007-1.045; P = 0.007) independently predicted early mortality. The area under value was 0.769 (95% CI: 0.674-0.863, P < .001) for the corrected QT interval and 0.780 (95% CI:0.681-0.878; P < .001) for the Global Registry of Acute Coronary Events risk score alone. However, when the corrected QT interval and the Global Registry of Acute Coronary Events risk score were combined, it was found to be 0.808 (95% CI: 0.713-0.904, P < .001).
Conclusion:
This study is the first to report that prolonged corrected QT and the Global Registry of Acute Coronary Events risk score independently predict early mortality and a combina- tion of these 2 factors may improve the predictive value for early mortality in patients with ST-segment elevation acute coronary syndrome.
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