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Published on: January 28, 2020
Independent and Incremental Prognostic Value of the Endothelial Activation and Stress Index Beyond the GRACE Score
1Department of Cardiology, Private Gazi Hospital, Izmir 35230, Turkey.
Insights
The Endothelial Activation and Stress Index (EASIX) effectively predicts 1-year mortality in non-ST-segment elevation myocardial infarction (NSTEMI) patients. This simple index offers valuable prognostic information beyond the existing GRACE score for improved risk stratification.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Biomarkers
Background:
- Non-ST-segment elevation myocardial infarction (NSTEMI) carries significant mortality despite advancements.
- Accurate risk stratification is crucial for guiding clinical decisions in NSTEMI patients.
- The Endothelial Activation and Stress Index (EASIX) shows promise but its role in NSTEMI needs clarification.
Purpose of the Study:
- To evaluate the association between EASIX and 1-year mortality in NSTEMI patients.
- To determine if EASIX provides incremental prognostic value beyond the GRACE risk score.
Main Methods:
- Retrospective analysis of 624 NSTEMI patients undergoing coronary angiography.
- EASIX calculated from admission lactate dehydrogenase, serum creatinine, and platelet count.
- Prognostic significance assessed using Cox models, Kaplan-Meier analysis, and restricted cubic splines.
Main Results:
- 1-year mortality was 12.0% (75 patients).
- Higher admission EASIX was significantly associated with increased mortality (p < 0.001).
- EASIX independently predicted mortality and improved risk prediction when added to the GRACE score (ΔAUC = 0.015, p = 0.032).
Conclusions:
- Admission EASIX is an independent predictor of 1-year mortality in NSTEMI.
- EASIX offers incremental prognostic information beyond the GRACE score.
- EASIX is a simple, inexpensive tool for risk stratification in NSTEMI.
Abstract:
Background and Objectives: Risk stratification is an important tool for guiding clinical decision-making in patients with non-ST-segment elevation myocardial infarction (NSTEMI), yet mortality remains considerable despite contemporary therapeutic advances. Endothelial Activation and Stress Index (EASIX), calculated using lactate dehydrogenase, serum creatinine, and platelet count, is a readily available composite prognostic index that has demonstrated prognostic value across various cardiovascular settings. However, its role in NSTEMI has not been fully established. We therefore evaluated the association between EASIX and 1-year mortality and examined whether it provides incremental prognostic information beyond the GRACE risk score. Materials and Methods: We retrospectively evaluated 624 consecutive patients with NSTEMI who underwent invasive coronary angiography. EASIX was calculated from laboratory parameters obtained at admission. The prognostic significance of EASIX was evaluated using Cox proportional hazards models, Kaplan-Meier survival analysis, restricted cubic spline modelling, and incremental performance metrics. Results: During 1-year follow-up, 75 patients (12.0%) died. Admission EASIX values were higher among non-survivors than survivors (p < 0.001). Mortality increased progressively across EASIX tertiles (p < 0.001). In multivariable analyses, log2(EASIX) remained independently associated with mortality both in the clinical model (HR 1.381, p = 0.002) and after adjustment for the GRACE score (HR 1.315, p = 0.005). Restricted cubic spline analyses supported a graded relationship between EASIX and mortality risk. Addition of EASIX to the GRACE score improved discrimination (ΔAUC = 0.015, p = 0.032) and risk reclassification (continuous NRI = 0.385, p = 0.020). Conclusions: Admission EASIX emerged as an independent predictor of 1-year mortality among patients with NSTEMI. Furthermore, it provides incremental prognostic information beyond the GRACE risk score and may represent a simple, inexpensive, and readily available tool for risk stratification in contemporary NSTEMI practice.