.: ORİJİNAL ARAŞTIRMA
Can GRACE Risk Score Predict the in-hospital Symtomatic Heart Failure Development After Myocardial Infarction Without ST Segment Elevation?
GRACE Risk Skoru ST Yükselmesiz Miyokard İnfarktüsü Sonrası Semptomatik Kalp Yetersizliği Gelişimini Öngörebilir mi?
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(1):1-8
doi: 10.5336/cardiosci.2019-70309
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has a prognostic significance in patients with myocardial infarction without ST segment elevation (NSTEMI). In this study, we aimed to evaluate the significance of GRACE score at day 1 in predicting the development of in-hospital symptomatic heart failure (IH-HF) in patients presenting with NSTEMI. Material and Methods: Consecutive patients, admitted with NSTEMI between April 2016-May 2017 were evaluated in this prospective cohort study. A total of 179 patients (112 male, the mean age: 65.4±11.2) with left ventricular ejection fraction (LV-EF) <50% and N-terminal pro Btype natriuretic peptide (NT-proBNP) level >125pg/mL along with Killip Class <II symptoms at admission were included in the study. GRACE score at day 1 was calculated according to original scoring system. During hospitalization period, patients who developed Killip Class (KC) ≥2 symptoms after day 1 to discharge were classified as IH-HF (n=55) and others were classified as NIH-HF (n=124). Results: The morbidity and mortality rates were higher in the IH-HF group. Not only GRACE score at day 1 but also atrial fibrillation (AF), three vessel disease, diabetes mellitus (DM) were found to be independent predictors of IH-HF. According to the ROC analysis, the patients with GRACE score at day 1 > 177.5 were found to be at higher risk for IH-HF development. Conclusion: The development of IH-HF in patients presenting with NSTEMI with asymptomatic left ventricular dysfunction significantly increases the morbidity and mortality rates. High GRACE score at day 1 in NSTEMI patients can be used to predict IH-HF.
Keywords: Myocardial infarction without ST segment elevation; heart failure; morbidity; mortality
Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has a prognostic significance in patients with myocardial infarction without ST segment elevation (NSTEMI). In this study, we aimed to evaluate the significance of GRACE score at day 1 in predicting the development of in-hospital symptomatic heart failure (IH-HF) in patients presenting with NSTEMI. Material and Methods: Consecutive patients, admitted with NSTEMI between April 2016-May 2017 were evaluated in this prospective cohort study. A total of 179 patients (112 male, the mean age: 65.4±11.2) with left ventricular ejection fraction (LV-EF) <50% and N-terminal pro Btype natriuretic peptide (NT-proBNP) level >125pg/mL along with Killip Class <II symptoms at admission were included in the study. GRACE score at day 1 was calculated according to original scoring system. During hospitalization period, patients who developed Killip Class (KC) ≥2 symptoms after day 1 to discharge were classified as IH-HF (n=55) and others were classified as NIH-HF (n=124). Results: The morbidity and mortality rates were higher in the IH-HF group. Not only GRACE score at day 1 but also atrial fibrillation (AF), three vessel disease, diabetes mellitus (DM) were found to be independent predictors of IH-HF. According to the ROC analysis, the patients with GRACE score at day 1 > 177.5 were found to be at higher risk for IH-HF development. Conclusion: The development of IH-HF in patients presenting with NSTEMI with asymptomatic left ventricular dysfunction significantly increases the morbidity and mortality rates. High GRACE score at day 1 in NSTEMI patients can be used to predict IH-HF.
Keywords: Myocardial infarction without ST segment elevation; heart failure; morbidity; mortality
ÖZET
Amaç: Akut Koroner Olaylarda Küresel Kayıt (GRACE) risk skoru, ST segment yükselmesiz miyokard infarktüslü (NSTEMI) hastalarda prognostik bir öneme sahiptir. Bu çalışmada, NSTEMI ile başvuran hastalarda hastane içi semptomatik kalp yetmezliğinin (IH-HF) gelişimini öngörmede 1. gün GRACE skorunun önemini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Nisan 2016-Mayıs 2017 tarihleri arasında NSTEMI ile başvuran ardışık hastalar bu prospektif kohort çalışmasında değerlendirildi. Sol ventrikül ejeksiyon fraksiyonu (LVEF) <%50 ve N-terminal pro-B tip natriüretik peptid (NT-proBNP) seviyesi >125 pg/mL olan Killp sınıf < II olan 179 hasta (112 erkek, ortalama yaş: 65,4±11,2) çalışmaya dahil edildi. Birinci gün GRACE skoru orjinal skorlama sistemine göre hesaplandı. Hastanede yatış süresi sırasında, 1. günden sonra taburcu olmak üzere Killip Sınıfı (KC) ≥2 semptomları gelişen hastalar IH-HF (n=55) ve diğerleri (hastanede yatmadan) NIH-HF (n=124) olarak sınıflandırıldı. Bulgular: IH-HF grubunda morbidite ve mortalite oranları daha yüksekti. Birinci gün GRACE skoruna ek olarak; atriyal fibrilasyon (AF), üç damar hastalığı, diabetes mellitus (DM), IH-HF'nin bağımsız belirleyicileri olarak bulundu. ROC analizine göre, 1. gün GRACE skoru > 177,5. olan hastaların İH-HF gelişimi için daha yüksek risk altında oldukları bulundu. Sonuç: Asemptomatik sol ventrikül disfonksiyonu olan NSTEMI ile başvuran hastalarda IH-HF gelişimi, morbidite ve mortalite oranlarını önemli ölçüde arttırır. NSTEMI hastalarında 1. günde yüksek GRACE skoru, IH-HF'yi tahmin etmek için kullanılabilir.
Anahtar Kelimeler: ST segment yükselmesiz miyokard infarktüsü; kalp yetersizliği; morbidite; mortalite
Amaç: Akut Koroner Olaylarda Küresel Kayıt (GRACE) risk skoru, ST segment yükselmesiz miyokard infarktüslü (NSTEMI) hastalarda prognostik bir öneme sahiptir. Bu çalışmada, NSTEMI ile başvuran hastalarda hastane içi semptomatik kalp yetmezliğinin (IH-HF) gelişimini öngörmede 1. gün GRACE skorunun önemini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Nisan 2016-Mayıs 2017 tarihleri arasında NSTEMI ile başvuran ardışık hastalar bu prospektif kohort çalışmasında değerlendirildi. Sol ventrikül ejeksiyon fraksiyonu (LVEF) <%50 ve N-terminal pro-B tip natriüretik peptid (NT-proBNP) seviyesi >125 pg/mL olan Killp sınıf < II olan 179 hasta (112 erkek, ortalama yaş: 65,4±11,2) çalışmaya dahil edildi. Birinci gün GRACE skoru orjinal skorlama sistemine göre hesaplandı. Hastanede yatış süresi sırasında, 1. günden sonra taburcu olmak üzere Killip Sınıfı (KC) ≥2 semptomları gelişen hastalar IH-HF (n=55) ve diğerleri (hastanede yatmadan) NIH-HF (n=124) olarak sınıflandırıldı. Bulgular: IH-HF grubunda morbidite ve mortalite oranları daha yüksekti. Birinci gün GRACE skoruna ek olarak; atriyal fibrilasyon (AF), üç damar hastalığı, diabetes mellitus (DM), IH-HF'nin bağımsız belirleyicileri olarak bulundu. ROC analizine göre, 1. gün GRACE skoru > 177,5. olan hastaların İH-HF gelişimi için daha yüksek risk altında oldukları bulundu. Sonuç: Asemptomatik sol ventrikül disfonksiyonu olan NSTEMI ile başvuran hastalarda IH-HF gelişimi, morbidite ve mortalite oranlarını önemli ölçüde arttırır. NSTEMI hastalarında 1. günde yüksek GRACE skoru, IH-HF'yi tahmin etmek için kullanılabilir.
Anahtar Kelimeler: ST segment yükselmesiz miyokard infarktüsü; kalp yetersizliği; morbidite; mortalite
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