Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Ma, Xiaoteng; Shao, Qiaoyu; Li, Qiu-Xuan; Yang, Zhiqiang; Han, Kangning; Liang, Jing; Shen, Hua; Zhou, Yujie; Wang, Zhijian

doi:10.3389/fcvm.2021.773200

Cited by 17 publications

(15 citation statements)

References 59 publications

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“…Malnutrition is a common risk factor for poor prognosis in various populations, whether assessed by subjective or objective tools or single biomarkers. [ 5 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] Our findings confirmed its prognostic significance in patients with CAD and coexisting abnormal glycemic status. Notably, we presented a novel finding that the malnutrition-related risk for all-cause death and MACCE outweighed the diabetes-related risk.…”

Section: Discussionsupporting

confidence: 78%

“…The diabetes group comprised more malnourished patients than the prediabetes group, which may have resulted from increased protein catabolism, decreased protein anabolism, elevated urinary protein excretion, and probably, inadequate protein intake in the setting of diabetes. Prior small-scale research has investigated malnutrition in older patients with diabetes [ 16 , 17 , 19 ] and patients with ACS [ 5 , 8 , 14 , 15 ], respectively, and may not have been epidemiologically representative of the general population with abnormal glycemic status and CAD. Only one study [ 13 ] reported malnutrition in CAD patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…The growing population of patients with CAD and comorbid abnormal glycemic status has been a major public health problem in both developed and developing countries [ 11 , 12 ]. The current evidence raises awareness of the impact of nutritional status on the prognosis of patients with CAD [ 5 , 8 , 13 , 14 , 15 ] or diabetes [ 16 , 17 , 18 , 19 ]. However, most studies focused only on acute coronary syndrome (ACS) or elderly patients with diabetes lack the knowledge of the overall population with combined traits.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Wang²,

Liu

et al. 2023

Nutrients

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This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate–severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate–severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Wang²,

Liu

et al. 2023

Nutrients

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“…Several previous studies have identified some potential risk factors combined with the GRACE score, which attempted to enhance the predictive ability for adverse clinical outcomes after ACS, such as nutritional risk index [ 25 ], neutrophil count [ 26 ], B-type natriuretic peptide [ 27 ], 2-hour postload glucose [ 28 ], and hemoglobin A1c [ 23 ]. The populations enrolled in the above studies were patients with STEMI or nondiabetic patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

Adjustment of the GRACE score by the triglyceride glucose index improves the prediction of clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Xiong

Chen

et al. 2022

Cardiovasc Diabetol

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Background The Global Registry of Acute Coronary Events (GRACE) score derived from clinical parameters at the time of hospital discharge is a powerful predictor of long-term mortality and reinfarction after acute coronary syndrome (ACS). The triglyceride glucose (TyG) index, which is a simple and reliable surrogate marker of insulin resistance, has been demonstrated to be an independent predictor of long-term adverse major adverse cardiac events, irrespective of diabetes mellitus. We investigate whether the addition of the TyG index improves the predictive ability of the GRACE score after percutaneous coronary intervention (PCI) in ACS patients regardless of diabetes mellitus. Method A retrospective cohort of 986 ACS patients undergoing PCI was enrolled in the present analyses. The GRACE score for discharge to 6 months and the TyG index were calculated. The primary endpoint was the composite of MACEs, including all-cause death and nonfatal myocardial infarction. Patients were stratified according to the primary endpoint and the tertiles of the TyG index. Cumulative curves were calculated using the Kaplan–Meier method. Multivariate Cox regression was adopted to identify predictors of MACEs. The predictive value of the GRACE score alone and combined with the TyG index or fasting blood glucose (FBG) was estimated by the area under the receiver‑operating characteristic curve, likelihood ratio test, Akaike’s information criteria, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Internal validation was assessed using the means of bootstrap method with 1000 bootstrapped samples. Results During a median follow-up of 30.72 months ((interquartile range, 26.13 to 35.07 months), 90 patients developed MACEs, more frequently in the patients with a higher TyG index. Multivariate Cox hazards regression analysis found that the TyG index, but not FBG was an independent predictor of MACEs (hazard ratio 1.6542; 95% CI 1.1555–2.3681; P = 0.006) in all types of ACS regardless of diabetes mellitus when included in the same model as GRACE score. Furthermore, Kaplan–Meier analysis revealed that the incidence of the primary endpoint rose with increasing TyG index tertiles (log-rank, P < 0.01). Adjustment the GRACE score by the TyG index improved the predictive ability for MACEs (increase in C-statistic value from 0.735 to 0.744; NRI, 0.282, 95% CI 0.028–0.426, P = 0.02; IDI, 0.019, 95% CI 0.004–0.046, P = 0.01). Likelihood ratio test showed that the TyG index significantly improved the prognostic ability of the GRACE score (χ2 = 12.37, 1 df; P < 0.001). The results remained consistent when the models were confirmed by internal bootstrap validation method. Conclusion The TyG index, but not FBG is an independent predictor of long-term MACEs after PCI in all types of ACS patients regardless of diabetes mellitus after adjusting for the GRACE score, and improves the ability of the GRACE score to stratify risk and predict prognosis of ACS patients undergoing PCI.

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“…Although it is well established that the strong and effective prognostic value of the GRACE score has been confirmed by much evidence ( 3 , 4 , 19 – 21 ), early risk stratification remains urgently needed for further optimization, especially for low-risk patients with ACS. Therefore, previous studies have recently explored ways to improve the predictability of the prognostic GRACE score, including adding NT-pro-BNP ( 22 ), 2-h postload plasma glucose ( 23 ), plasma glucose blood inflammation-related indicators ( 24 ), plasma myeloperoxidase and trimethylamine N-oxide ( 25 ), serum acid uric acid ( 26 ) and nutritional risk index ( 27 ) to the GRACE score. The findings indicate that blood biochemical indexes and biomarkers provide incremental prognostic information for the predictive capacity of the GRACE score-based prognostic models.…”

Section: Discussionmentioning

confidence: 99%

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

Duan

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiac 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.MethodPatients 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).ResultsOverall, 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 (χ2 = 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).ConclusionDC 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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Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Cited by 17 publications

References 59 publications

Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Adjustment of the GRACE score by the triglyceride glucose index improves the prediction of clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

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

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