Anemia, Hyperglycemia, and Reduced Left Ventricular Ejection Fraction Improve the GRACE Score's Predictability for
Iswandy Janetputra Turu' Allo1,2, Miftah Pramudyo1, Mohammad Rizki Akbar1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Insights
Adding anemia, hyperglycemia, and reduced left ventricular ejection fraction (LVEF) to the Global Registry of Acute Coronary Events (GRACE) score enhances prediction of in-hospital mortality in Acute Coronary Syndrome (ACS) patients. This improved score offers better risk stratification for clinical decisions.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Acute Coronary Syndrome Management
Background:
- Acute Coronary Syndrome (ACS) poses significant mortality risks.
- Current risk stratification tools like the Global Registry of Acute Coronary Events (GRACE) score have limitations in predicting in-hospital mortality.
- Identifying additional predictive factors is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the predictive value of incorporating anemia, hyperglycemia, and left ventricular ejection fraction (LVEF) into the GRACE score.
- To assess the impact of these parameters on in-hospital mortality prediction in ACS patients.
- To determine if a modified GRACE score offers improved risk stratification.
Main Methods:
- A single-center, cross-sectional study of 634 ACS patients.
- Anemia defined by hemoglobin levels, hyperglycemia by random blood glucose (RBG) ≥200 mg/dL, and reduced LVEF by <50%.
- Comparative analysis of GRACE score alone versus the modified score using AUC, C-statistics, cNRI, and IDI.
Main Results:
- Anemia (31.1%), hyperglycemia (19.4%), and reduced LVEF (57.4%) were prevalent in the study cohort.
- Anemia, hyperglycemia, and reduced LVEF were confirmed as independent predictors of in-hospital mortality.
- The modified GRACE score demonstrated increased predictive accuracy with a higher AUC (0.862) compared to the standard GRACE score (0.839).
Conclusions:
- Incorporating anemia, hyperglycemia, and reduced LVEF significantly improves the predictive capacity of the GRACE score for in-hospital mortality in ACS.
- The enhanced GRACE score serves as a more robust tool for clinical risk stratification and decision-making in ACS patients.
- This modified approach aids clinicians in better identifying high-risk individuals for timely intervention.
Purpose:
This study investigates the predictive value of incorporating anemia, hyperglycemia, and left ventricular ejection fraction (LVEF) into the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in Acute Coronary Syndrome (ACS).
Patients And Methods:
We conducted a single-center, cross-sectional study involving 634 ACS patients admitted to Dr. Hasan Sadikin General Hospital between 2021 and 2023. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women, while hyperglycemia was indicated with random blood glucose (RBG) ≥200 mg/dL at admission. Patients with LVEF <50% were classified as having reduced LVEF. The primary outcome was in-hospital mortality. Model goodness-of-fit was assessed using R2 and the Hosmer-Lemeshow's test. The predictive accuracy of the GRACE score alone and combined with these parameters were evaluated through receiver operating characteristic curve analysis, an area under the curve (AUC), and concordance (C)-statistics. Reclassification improvement was quantified using continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI).
Results:
Among 634 patients (mean age 58.10±11.08 years old; 80.3% male), anemia, hyperglycemia, and reduced LVEF were observed in 197 (31.1%), 123 (19.4%), and 364 (57.4%) patients, respectively. The in-hospital mortality rate was 6.6%. Regression analysis identified nine predictors of mortality, with anemia, hyperglycemia, and reduced LVEF confirmed as independent predictors. The GRACE score showed an AUC of 0.839 (95% confidence interval/CI 0.77-0.0.90). Incorporating anemia, hyperglycemia, and reduced LVEF increased the AUC to 0.862 (95% CI 0.81-0.91), enhancing predictive accuracy (p = 0.590). Combining these variables yielded an NRI of 0.075 (p = 0.070) and an IDI of 0.035 (p = 0.029).
Conclusion:
Incorporating anemia, hyperglycemia, and reduced LVEF into the GRACE score improves its predictive capacity for in-hospital mortality in ACS patients. The modified GRACE score offers a more robust risk stratification tool for clinical practice and decision-making.
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