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Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome

BACKGROUND: Cardiac autonomic nerve imbalance has been well documented to provide a critical foundation for the development of acute coronary syndrome (ACS) but is not included in the postdischarge GRACE score. We investigated whether capturing cardiac autonomic nervous system (ANS)-related modulati...

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Autores principales: Duan, Shoupeng, Wang, Jun, Yu, Fu, Song, Lingpeng, Liu, Chengzhe, Sun, Ji, Deng, Qiang, Wang, Yijun, Zhou, Zhen, Guo, Fuding, Zhou, Liping, Wang, Yueyi, Tan, Wuping, Jiang, Hong, Yu, Lilei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091655/
https://www.ncbi.nlm.nih.gov/pubmed/35571153
http://dx.doi.org/10.3389/fcvm.2022.888753
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author Duan, Shoupeng
Wang, Jun
Yu, Fu
Song, Lingpeng
Liu, Chengzhe
Sun, Ji
Deng, Qiang
Wang, Yijun
Zhou, Zhen
Guo, Fuding
Zhou, Liping
Wang, Yueyi
Tan, Wuping
Jiang, Hong
Yu, Lilei
author_facet Duan, Shoupeng
Wang, Jun
Yu, Fu
Song, Lingpeng
Liu, Chengzhe
Sun, Ji
Deng, Qiang
Wang, Yijun
Zhou, Zhen
Guo, Fuding
Zhou, Liping
Wang, Yueyi
Tan, Wuping
Jiang, Hong
Yu, Lilei
author_sort Duan, Shoupeng
collection PubMed
description BACKGROUND: Cardiac autonomic nerve imbalance has been well documented to provide a critical foundation for the development of acute coronary syndrome (ACS) but is not included in the postdischarge GRACE score. We investigated whether capturing cardiac autonomic nervous system (ANS)-related modulations by 24-h deceleration capacity (DC) could improve the capability of existing prognostic models, including the postdischarge Global Registry of Acute Coronary Events (GRACE) score, to predict prognosis after ACS. METHOD: Patients with ACS were assessed with 24-h Holter monitoring in our department from June 2017 through June 2019. The GRACE score was calculated for postdischarge 6-month mortality. The patients were followed longitudinally for the incidence of major adverse cardiac events (MACEs), set as a composite of non-fatal myocardial infarction and death. To evaluate the improvement in its discriminative and reclassification capabilities, the GRACE score with DC model was compared with a model using the GRACE score only, using area under the receiver-operator characteristic curve (AUC), Akaike's information criteria, the likelihood ratio test, category-free integrated discrimination index (IDI) and continuous net reclassification improvement (NRI). RESULTS: Overall, 323 patients were enrolled consecutively. After the follow-up period (mean, 43.78 months), 41 patients were found to have developed MACEs, which were more frequent among patients with DC <2.5 ms. DC adjusted for the GRACE score independently predicted the occurrence of MACEs with an adjusted hazard ratio (HR) of 0.885 and 95% CI of 0.831–0.943 (p < 0.001). Moreover, adding DC to the GRACE score only model increased the discriminatory ability for MACEs, as indicated by the likelihood ratio test (χ(2) = 9.277, 1 df; p < 0.001). The model including the GRACE score combined with DC yielded a lower corrected Akaike's information criterion compared to that with the GRACE score alone. Incorporation of the DC into the existing model that uses the GRACE score enriched the net reclassification indices (NRIe(>0) 7.3%, NRIne(>0) 12.8%, NRI(>0) 0.200; p = 0.003). Entering the DC into the GRACE score model enhanced discrimination (IDI of 1.04%, p < 0.001). CONCLUSION: DC serves as an independent and effective predictor of long-term adverse outcomes after ACS. Integration of DC and the postdischarge GRACE score significantly enhanced the discriminatory capability and precision in the prediction of poor long-term follow-up prognosis.
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spelling pubmed-90916552022-05-12 Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome Duan, Shoupeng Wang, Jun Yu, Fu Song, Lingpeng Liu, Chengzhe Sun, Ji Deng, Qiang Wang, Yijun Zhou, Zhen Guo, Fuding Zhou, Liping Wang, Yueyi Tan, Wuping Jiang, Hong Yu, Lilei Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Cardiac autonomic nerve imbalance has been well documented to provide a critical foundation for the development of acute coronary syndrome (ACS) but is not included in the postdischarge GRACE score. We investigated whether capturing cardiac autonomic nervous system (ANS)-related modulations by 24-h deceleration capacity (DC) could improve the capability of existing prognostic models, including the postdischarge Global Registry of Acute Coronary Events (GRACE) score, to predict prognosis after ACS. METHOD: Patients with ACS were assessed with 24-h Holter monitoring in our department from June 2017 through June 2019. The GRACE score was calculated for postdischarge 6-month mortality. The patients were followed longitudinally for the incidence of major adverse cardiac events (MACEs), set as a composite of non-fatal myocardial infarction and death. To evaluate the improvement in its discriminative and reclassification capabilities, the GRACE score with DC model was compared with a model using the GRACE score only, using area under the receiver-operator characteristic curve (AUC), Akaike's information criteria, the likelihood ratio test, category-free integrated discrimination index (IDI) and continuous net reclassification improvement (NRI). RESULTS: Overall, 323 patients were enrolled consecutively. After the follow-up period (mean, 43.78 months), 41 patients were found to have developed MACEs, which were more frequent among patients with DC <2.5 ms. DC adjusted for the GRACE score independently predicted the occurrence of MACEs with an adjusted hazard ratio (HR) of 0.885 and 95% CI of 0.831–0.943 (p < 0.001). Moreover, adding DC to the GRACE score only model increased the discriminatory ability for MACEs, as indicated by the likelihood ratio test (χ(2) = 9.277, 1 df; p < 0.001). The model including the GRACE score combined with DC yielded a lower corrected Akaike's information criterion compared to that with the GRACE score alone. Incorporation of the DC into the existing model that uses the GRACE score enriched the net reclassification indices (NRIe(>0) 7.3%, NRIne(>0) 12.8%, NRI(>0) 0.200; p = 0.003). Entering the DC into the GRACE score model enhanced discrimination (IDI of 1.04%, p < 0.001). CONCLUSION: DC serves as an independent and effective predictor of long-term adverse outcomes after ACS. Integration of DC and the postdischarge GRACE score significantly enhanced the discriminatory capability and precision in the prediction of poor long-term follow-up prognosis. Frontiers Media S.A. 2022-04-27 /pmc/articles/PMC9091655/ /pubmed/35571153 http://dx.doi.org/10.3389/fcvm.2022.888753 Text en Copyright © 2022 Duan, Wang, Yu, Song, Liu, Sun, Deng, Wang, Zhou, Guo, Zhou, Wang, Tan, Jiang and Yu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Duan, Shoupeng
Wang, Jun
Yu, Fu
Song, Lingpeng
Liu, Chengzhe
Sun, Ji
Deng, Qiang
Wang, Yijun
Zhou, Zhen
Guo, Fuding
Zhou, Liping
Wang, Yueyi
Tan, Wuping
Jiang, Hong
Yu, Lilei
Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title_full Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title_fullStr Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title_full_unstemmed Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title_short Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome
title_sort enrichment of the postdischarge grace score with deceleration capacity enhances the prediction accuracy of the long-term prognosis after acute coronary syndrome
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091655/
https://www.ncbi.nlm.nih.gov/pubmed/35571153
http://dx.doi.org/10.3389/fcvm.2022.888753
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