Admission high‐sensitivity C‐reactive protein levels improve the Grace risk score prediction on in‐hospital outcomes in acute myocardial infarction patients

BACKGROUND: Acute myocardial infarction (AMI) is the main cause of death and disability in cardiovascular and cerebrovascular diseases. Both the Global Registry of Acute Coronary Events (Grace) score and high‐sensitivity C‐reactive protein (hs‐CRP) were associated with prognosis in patients with AMI. However, whether the addition of the hs‐CRP to Grace risk score could improve the predictive power of Grace risk score on the prognosis of patients with AMI is unclear. Hypothesis: We hypothesized that the inclusion of hs‐CRP in the Grace risk score could improve the ability to correctly distinguish the occurrence of in‐hospital outcomes. METHODS: We retrospectively enrolled 1804 patients with AMI in the final analysis. Patients were divided into four groups by hs‐CRP quartiles. The relation between hs‐CRP and Grace risk score was analyzed by Spearman rank correlation. Logistic regression was used to identify independent risk factors. The predictive value of hs‐CRP add to Grace risk score was evaluated by C‐statistic, net reclassification improvement (NRI), integrated differentiation improvement (IDI), calibration plot, and decision curve analysis. RESULTS: The hs‐CRP and Grace risk score had a significantly positive correlation (r = .191, p < .001). hs‐CRP combined with Grace risk score could improve the ability of Grace risk score alone to correctly redistinguish the occurrence of in‐hospital outcome (C‐statistic = 0.819, p < .001; NRI = 0.05956, p = .007; IDI = 0.0757, p < .001). CONCLUSION: Admission hs‐CRP level was a significant independent risk factor for in‐hospital outcomes in patients with AMI. The inclusion of hs‐CRP in the Grace risk score could improve the ability to correctly distinguish the occurrence of in‐hospital outcomes.