Adjustment of the GRACE score by the stress hyperglycemia ratio improves the prediction of long-term major adverse cardiac events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A multicenter retrospective study. (April 2023)

• Record Type: Journal Article
• Authors: Xiong, Shiqiang; Luo, Yan; Chen, Qiang; Chen, Yingzhong; Su, Hong; Long, Yu; Chen, Xu; Yang, Siqi; Qi, Lingyao; Huang, Wenchao; Hou, Jun; Liu, Hanxiong; Cai, Lin
• Is Part Of: Diabetes research and clinical practice. Volume 198(2023)
• Publication Date: 2023-04
• Subjects: Acute coronary syndrome -- Blood glucose -- Stress hyperglycemia ratio -- GRACE score -- Percutaneous coronary intervention -- Prognosis; GRACE score indicates The Global Registry of Acute Coronary Events score -- PCI percutaneous coronary intervention -- COPD chronic obstructive pulmonary disease -- SBP systolic blood pressure -- HR heart rate -- BNP brain natriuretic peptide -- SHR stress hyperglycemia ratio -- HbA1c glycosylated hemoglobin -- ABG admission blood glucose -- TG triglyceride -- TC total cholesterol -- HDL high density lipoprotein-C -- LDL low density lipoprotein-C -- LVEF left ventricular ejection fraction -- AMI acute myocardial infarction -- STEMI ST-segment elevation myocardial infarction -- NSTEMI non-ST-segment elevation myocardial infarction -- PCI percutaneous transluminal coronary intervention -- ACEI/ARB angiotensin converting enzyme inhibitor/angiotensin receptor blocker -- ROC receiver operating characteristic -- NRI net reclassification improvement -- IDI integrated discrimination improvement; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2023.110601
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: The predictive value of the stress hyperglycemia ratio (SHR) for long-term prognosis in acute coronary syndrome (ACS) is inconsistent. Whether the SHR provides additional prognostic value in addition to the GRACE score in ACS patients undergoing percutaneous coronary intervention (PCI) remains unknown. Methods: A development–validation method was adopted to develop an algorithm to adjust the GRACE score using the SHR in ACS patients undergoing PCI from 11 hospitals. Results: During a median follow-up of 31.33 months, the occurrence of major adverse cardiac events (MACEs), defined as a composite of all-cause mortality and nonfatal myocardial infarction, was more frequent in the patients with a higher level of SHR. The SHR independently predicted long-term MACEs (hazard ratio 3.3479; 95% CI 1.4103–7.9475; P = 0.0062). Adjustment of the GRACE risk by addition of the SHR increased the C-statistic from 0.706 (95% CI: 0.599–0.813) to 0.727 (95% CI: 0.616–0.837) (P < 0.01), with a continuous net reclassification improvement of 30.5% and an integrated discrimination improvement of 0.042 (P < 0.01) in the derivation cohort; and addition of the SHR showed superior discrimination and good calibration in the validation cohort. Conclusions: The SHR is an independent predictor of long-term MACEs in ACS patients undergoing PCI and markedly improves the performance of the GRACE score.