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. 2022 Aug 2:14:911-923.
doi: 10.2147/CLEP.S370004. eCollection 2022.

A Novel Biomarker Scoring System Alone or in Combination with the GRACE Score for the Prognostic Assessment in Non-ST-Elevation Myocardial Infarction

Yao Yao #  1 , Chunlai Shao #  2 , Xiaoye Li  1 , Zi Wang  1 , Chengchun Zuo  1 , Yan Yan  3 , Qianzhou Lv  1
Affiliations

A Novel Biomarker Scoring System Alone or in Combination with the GRACE Score for the Prognostic Assessment in Non-ST-Elevation Myocardial Infarction

Yao Yao et al. Clin Epidemiol. .

Abstract

Purpose: The Global Registry of Acute Coronary Events (GRACE) score has proven value in predicting short-term prognosis in non-ST-elevation myocardial infarction (NSTEMI), but it has only moderate discrimination for long-term outcomes. The purpose of this study is to develop and test a multi-biomarker score for better risk stratification and indication of 2-year risk in patients with NSTEMI.

Patients and methods: A total of 6076 consecutive patients with NSTEMI (66 [59-73] years, 73.1% males) admitted at Zhongshan Hospital, Fudan University were collected in this observational, prospective study between 2012 and 2018 with a 24-month follow-up. The primary endpoint was all-cause death and non-fatal major adverse cardiac events (MACE). A biomarker score ranged from 0 to 12 was constructed. The predictive power of the biomarker score was evaluated alone or combined with the GRACE score by C-statistic, net reclassification index (NRI) and integrated discrimination index (IDI).

Results: During a 2-year follow-up, all-cause death occurred in 159 patients (2.6%), and non-fatal MACEs were presented in 709 patients (11.7%). When added to the GRACE score, the biomarker score demonstrated better prognostic accuracy, patient reclassification and risk discrimination for both mortality and non-fatal MACEs at 2 years by improving the C-statistic from 0.714 (0.671-0.756) and 0.623 (0.600-0.646) to 0.851 (0.820-0.882) and 0.721 (0.702-0.741) with NRI >25% (P<0.001) and IDI >0.30 (P<0.001).

Conclusion: The single use of biomarker score could markedly enhance the prognostic value of concurrent risk stratification tools for 2-year mortality and non-fatal MACEs in NSTEMI. The GRACE score with incorporation of the biomarker score led to more accurate risk reclassification and warrants more consideration in further NSTEMI management.

Keywords: integrated discrimination improvement; net reclassification improvement; prognosis; risk stratification.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Distribution of biomarker scores; (B) Distribution of GRACE scores; (C) Annual event rate of biomarker scores; (D) Annual event rate of GRACE scores.
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