The GRACE risk score in patients with ST-segment elevation myocardial infarction and concomitant COVID-19
Mariusz Wójcik1, Jakub Karpiak1, Lech Zaręba2
1Clinical Department of Cardiology with the Acute Coronary Syndromes Subdivision, Clinical Provincial Hospital No. 2, Rzeszow, Poland.
Insights
The GRACE risk score effectively predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. This finding aids in managing high-risk cardiac events during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute coronary syndrome (ACS) is a leading global cause of mortality.
- ST-segment elevation myocardial infarction (STEMI) in COVID-19 patients is rare but serious.
- Understanding mortality predictors in STEMI with COVID-19 is crucial.
Purpose of the Study:
- To characterize clinical and angiographic features of STEMI patients with COVID-19.
- To evaluate the GRACE risk score's ability to predict in-hospital mortality in this cohort.
- To identify optimal GRACE score cut-offs for mortality prediction.
Main Methods:
- Retrospective, single-center study of STEMI patients with confirmed COVID-19.
- Primary percutaneous coronary intervention was the treatment modality.
- Comparison of clinical, demographic, and angiographic data between survivors and non-survivors.
Main Results:
- The study included 25 STEMI and COVID-19 patients (92% male, median age 70).
- In-hospital mortality was 48% (12 deaths).
- Non-survivors exhibited higher hsCRP, D-dimer, and GRACE scores, with lower LVEF and TIMI 3 flow.
- The GRACE score predicted in-hospital death with an AUC of 0.788 (optimal cut-off: 176).
Conclusions:
- The GRACE risk score is a valuable tool for predicting in-hospital mortality in STEMI patients with concurrent COVID-19.
- Elevated inflammatory markers and reduced LVEF are associated with higher mortality.
- Further research may refine risk stratification in this complex patient group.
Introduction:
Acute coronary syndrome represents a major cause of mortality throughout the world. To date, there are only a few reports of ST-segment elevation type 1 myocardial infarction in patients with COVID-19. The aim of this study was to describe the clinical and angiographic characteristics alongside the prediction of in-hospital mortality using the GRACE risk score in this group.
Material And Methods:
This was a single-center, retrospective study of consecutive patients admitted to a multi-specialist hospital with confirmed ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention. Demographic, clinical and angiographic characteristics were compared between survivors and non-survivors.
Results:
Twenty-five patients, of whom 23 (92%) were men, with confirmed STEMI and COVID-19, with a median age of 70 years and high comorbidity burden, were included in this study. They were treated with percutaneous coronary intervention and 12 (48%) of them died. Non-survivors had elevated high-sensitivity C-reactive protein (hsCRP) (p = 0.026) and D-dimer (p = 0.042) and reduced left ventricular ejection fraction (30 ±9 vs. 41 ±7; p = 0.003). Postprocedural TIMI 3 flow grade was less frequently observed in this group (p = 0.039). There was a higher GRACE score in the non-survivor group (mean ± SD; 210 ±35 vs. 169 ±42, p = 0.014). In ROC analysis, GRACE score predicted in-hospital death with an AUC of 0.788 (95% CI: 0.6-0.98, p = 0.014). A score of 176 was identified as the optimal cut-off with a sensitivity of 92% and specificity of 69%.
Conclusions:
The GRACE risk score is a good predictor of in-hospital mortality in patients presenting with STEMI with concomitant COVID-19.
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