Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

Timóteo, Ana Teresa; Toste, Alexandra; Ramos, Rubén; Miranda, Fernando; Ferreira, Maria Lurdes; Oliveira, José Alberto; Ferreira, Rui Cruz

doi:10.1080/17482940903177036

Cited by 11 publications

(11 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Importantly, 31% of our population were correctly reclassified by the inclusion of the fatty acids, primarily driven by the 26% of the cohort that GRACE predicted would be alive but who, in fact, died. Some previous attempts to improve on the GRACE score prediction with novel markers have been successful 28;29 whereas others have not 30;31 .…”

Section: Discussionmentioning

confidence: 99%

Red blood cell fatty acid levels improve GRACE score prediction of 2-yr mortality in patients with myocardial infarction

Harris¹,

Kennedy²,

O’Keefe³

et al. 2013

International Journal of Cardiology

View full text Add to dashboard Cite

Background Blood omega-3 and omega-6 fatty acid levels have been associated with reduced risk for total mortality in patients with stable coronary heart disease (CHD), but their relationships with mortality in the setting of myocardial infarction (MI) are unknown. Objective To determine the association between red blood cell (RBC) fatty acid levels measured at admission and 2-year mortality in MI patients, independent of the GRACE risk score, a traditional mode of risk stratification, Design Admission RBC fatty acid levels were measured in patients enrolled in a prospective, 24-center MI registry (TRIUMPH). Two-year mortality was modeled with Cox proportional hazards regression to assess the extent to which the inclusion of fatty acid levels would improve, over and above the GRACE score, risk stratification for 2-year mortality. Results RBC fatty acid data were available from 1,144 patients who did not report taking fish oil supplements after discharge. Two RBC fatty acids [eicosapentaenoic acid (EPA n-3) and docosapentaenoic n-6 (DPA)] were univariate predictors of total mortality. The combined fatty acid c-statistic (0.60, p<0.001) improved the c-statistic of the GRACE score alone from 0.747 (p<0.001) to 0.768 (p<0.05 vs. GRACE alone). The net reclassification index improved by 31% (95% CI, 15% to 48%) and the relative incremental discrimination index improved by 19.8% (7.5% to 35.7%). Conclusion RBC EPA and DPA n-6 levels improved the prediction of 2-yr mortality over and above the GRACE score in MI patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Red blood cell fatty acid levels improve GRACE score prediction of 2-yr mortality in patients with myocardial infarction

Harris¹,

Kennedy²,

O’Keefe³

et al. 2013

International Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…Em concordância, os dois estudos que avaliaram o valor incremental de modelos multivariados apresentaram a mesma conclusão que a nossa. 7,8 As limitações metodológicas devem ser reconhecidas aqui, podendo ter promovido um resultado falso negativo. Primeiramente, sabe-se que, idealmente, um marcador de risco deve ser testado em um ambiente em que a equipe de atendimento não esteja ciente de seu resultado.…”

Section: Discussionunclassified

“…6 No entanto, do ponto de vista preditivo, se o NT-proBNP possui um valor incremental em relação aos modelos probabilísticos que já contêm Killip como variável preditora é uma questão controversa. [7][8][9] Entre os modelos validados para predição de risco, o escore GRACE é o de melhor precisão prognóstica, contendo a classe Killip como marcador de insuficiência cardíaca. [10][11][12] Nesta coorte, testamos a hipótese de que a incorporação de NT-proBNP aumenta o valor prognóstico do escore GRACE em pacientes com SCA.…”

Section: Introductionunclassified

Valor Prognóstico do NT-proBNP versus Classificação de Killip em Pacientes com Síndromes Coronarianas Agudas

et al. 2020

View full text Add to dashboard Cite

ResumoFundamento: Os níveis plasmáticos de peptídeos natriuréticos cerebrais têm melhor precisão diagnóstica em comparação com a avaliação clínico-radiológica para insuficiência cardíaca aguda. Nas síndromes coronárias agudas (SCA), o valor prognóstico da insuficiência cardíaca aguda é incorporado nos modelos preditivos através da classificação de Killip. Não está estabelecido se o NT-proBNP poderia aumentar a previsão prognóstica. Objetivo: Avaliar se o NT-proBNP, como medida da disfunção ventricular esquerda, melhora o valor prognóstico intra-hospitalar do escore GRACE na SCA. Métodos: Foram incluídos no estudo pacientes admitidos por dor torácica aguda, com eletrocardiograma e/ou critérios de troponina para SCA. O nível plasmático de NT-proBNP foi medido no momento da admissão hospitalar e o desfecho primário foi definido como morte cardiovascular durante a hospitalização. Foi considerado significativo o valor de p < 0,05. Resultados: A mortalidade cardiovascular entre os 352 pacientes estudados foi de 4,8%. O valor preditivo do NT-proBNP para morte cardiovascular foi mostrado por uma estatística C de 0,78 (IC 95% = 0,65-0,90). Após o ajuste para o modelo GRACE subtraído pela variável Killip, o NT-proBNP permaneceu independentemente associado à morte cardiovascular (p = 0,015). No entanto, a discriminação pelo modelo logístico GRACE-BNP (estatística C = 0,83; IC 95% = 0,69-0,97) não foi superior ao escore GRACE tradicional com Killip (estatística C = 0,82; IC 95% = 0,68-0,97). O modelo GRACE-BNP não proporcionou melhora na classificação dos pacientes de alto risco pelo Escore GRACE (índice líquido de reclassificação = -0,15; p = 0,14). Conclusão: Apesar da associação estatística com a morte cardiovascular, não houve evidências de que o NT-proBNP aumente o valor prognóstico do escore GRACE na SCA. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0) Palavras-chave: Síndrome Coronariana Aguda; Insuficiência Cardíaca; Peptídeo Natriurético Encefálico; Mortalidade; Disfunção Ventricular Esquerda; Biomarcadores. AbstractBackground: Plasma levels of brain natriuretic peptides have better diagnostic accuracy compared to clinical-radiologic judgment for acute heart failure. In acute coronary syndromes (ACS), the prognostic value of acute heart failure is incorporated into predictive models through Killip classification. It is not established whether NT-proBNP could increment prognostic prediction.Objective: To evaluate whether NT-proBNP, as a measure of left ventricular dysfunction, improves the in-hospital prognostic value of the GRACE score in ACS. Methods:Patients admitted due to acute chest pain, with electrocardiogram and/or troponin criteria for ACS were included in the study. The plasma level of NT-proBNP was measured at hospital admission and the primary endpoint was defined as cardiovascular death during hospitalization. P-value < 0.05 was considered as significant.Results: Among 352 patients studied, cardiovascular mortality was 4.8%. The predictive value of NT-proBNP for cardiovascular death was shown by ...

show abstract

“…ET-1 is known to be elevated in patients with CAD, especially in the post-MI period (44), and higher levels of sICAM-1 have been associated with cardiac events and mortality in patients with heart disease (7, 8). Finally, cardiac strain was measured through N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (cTnI), which have been linked to subsequent survival in patients with ACS (9–11). …”

Section: Methodsmentioning

confidence: 99%

Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome

et al. 2017

View full text Add to dashboard Cite

Objective Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients. Methods Participants (N=164) attended study visits 2 weeks and 6 months post-ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude, and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers. Results In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β=.047, 95% confidence interval [.010, .083]), endothelial dysfunction (endothelin-1: β=.020, [.004, .037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β=.045, [.008, .083]), independent of age, sex, medical variables, and anxiety, while anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β=−.009, [−.017, −.001]; optimism: β=−.009, [−.016, −.001]; soluble intercellular adhesion molecule-1: gratitude: β=−.007, [−.014, −.000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months. Conclusions Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months post-ACS, while positive psychological constructs were linked to better endothelial function. Larger, prospective studies may clarify the directionality of these relationships.

show abstract

Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

Cited by 11 publications

References 26 publications

Red blood cell fatty acid levels improve GRACE score prediction of 2-yr mortality in patients with myocardial infarction

Red blood cell fatty acid levels improve GRACE score prediction of 2-yr mortality in patients with myocardial infarction

Valor Prognóstico do NT-proBNP versus Classificação de Killip em Pacientes com Síndromes Coronarianas Agudas

Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome

Contact Info

Product

Resources

About