Risk Scores After Acute Coronary Syndrome

Objective: Fibroblast growth factor (FGF) 21 is a recently established therapeutic target for treating metabolic syndromes, which include potential precursors to cardiovascular disease, suggesting a link between FGF21 and atherosclerosis. However, the association between serum FGF21 concentrations and coronary artery disease remain controversial. The aim of this study is to evaluate the association between circulating FGF21 concentrations and coronary artery lesions and clinical severity. Methods: We enrolled 137 subjects who underwent coronary angiography, due to suspected acute coronary syndrome (ACS), from December 2009 to July 2012. Serum FGF21 levels were measured. Coronary artery lesions and clinical severities of the subjects were evaluated using the SYNergy between percutaneous coronary intervention with (paclitaxel-eluting) TAXus stent and cardiac surgery (SYNTAX) and Global Registry of Acute Coronary Events (GRACE) scoring system, respectively. Results: After adjusting for established cardiovascular disease risk factors, including age, body mass index, total cholesterol, and low-density lipoprotein cholesterol, patients with coronary artery lesions (n=112 men) had significantly higher levels of FGF21 than individuals without such lesions (n=25; men) (377.1±20.1 pg/mL vs. 267.1±43.5 pg/mL; p=0.026). However, no correlations were found between serum levels of FGF21 and either the calculated STNTAX score (r=0.117; p=0.176) or GRACE risk score, which is a risk prediction tool applicable for ACS subjects (r=0.113; p=0.193). Conclusion: Although serum levels of FGF21 were higher in individuals with coronary lesions than in those without such lesions, FGF21 levels were not associated with angiographic severity.

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“…The detailed methodologies for calculating the SYNTAX and GRACE scores have been described elsewhere. 13,14 …”

Section: Assessment Of the Severity Of Coronary Artery Occlusionmentioning

confidence: 99%

Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease

Park

Bae

Choi

et al. 2018

J Lipid Atheroscler

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“…Several other risk score models, such as the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry–Get With The Guidelines (GWTG) mortality risk score ( 4 , 6 ) from the United States, the China Acute Myocardial Infarction (CAMI) registry ( 8 , 9 ) or the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project ( 10 ), were also derived to predict in-hospital mortality. However, these risk score models have some limitations ( 16 – 19 ). First, some of the excluded patients had a high risk, and some were modeled after selected populations that enrolled non-consecutive patients.…”

Section: Introductionmentioning

confidence: 99%

A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort

Zhang

Wang

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesThe aim of this study was to develop and validate a novel risk score to predict in-hospital mortality in patients with acute myocardial infarction (AMI) using the Heart Failure after Acute Myocardial Infarction with Optimal Treatment (HAMIOT) cohort in China.MethodsThe HAMIOT cohort was a multicenter, prospective, observational cohort of consecutive patients with AMI in China. All participants were enrolled between December 2017 and December 2019. The cohort was randomly assigned (at a proportion of 7:3) to the training and validation cohorts. Logistic regression model was used to develop and validate a predictive model of in-hospital mortality. The performance of discrimination and calibration was evaluated using the Harrell’s c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The new simplified risk score was validated in an external cohort that included independent patients with AMI between October 2019 and March 2021.ResultsA total of 12,179 patients with AMI participated in the HAMIOT cohort, and 136 patients were excluded. In-hospital mortality was 166 (1.38%). Ten predictors were found to be independently associated with in-hospital mortality: age, sex, history of percutaneous coronary intervention (PCI), history of stroke, presentation with ST-segment elevation, heart rate, systolic blood pressure, initial serum creatinine level, initial N-terminal pro-B-type natriuretic peptide level, and PCI treatment. The c-statistic of the novel simplified HAMIOT risk score was 0.88, with good calibration (Hosmer–Lemeshow test: P = 0.35). Compared with the Global Registry of Acute Coronary Events risk score, the HAMIOT score had better discrimination ability in the training (0.88 vs. 0.81) and validation (0.82 vs. 0.72) cohorts. The total simplified HAMIOT risk score ranged from 0 to 121. The observed mortality in the HAMIOT cohort increased across different risk groups, with 0.35% in the low risk group (score ≤ 50), 3.09% in the intermediate risk group (50 < score ≤ 74), and 14.29% in the high risk group (score > 74).ConclusionThe novel HAMIOT risk score could predict in-hospital mortality and be a valid tool for prospective risk stratification of patients with AMI.Clinical Trial Registration[https://clinicaltrials.gov], Identifier: [NCT03297164].

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“…Для оценки риска развития возможных осложнений у пациентов с ОКС в настоящее время существует ряд прогностических моделей [11]. Наиболее распространёнными и применимыми в клинической практике являются шкалы TIMI и Grace [12][13][14][15][16][17]. Данные шкалы являются удобными в использовании, не требуют применения дорогостоящих лабораторных тестов, сложных математических расчетов.…”

Section: Introductionunclassified

Associations of Psychosocial Factors With Probable Hospital Mortality According to the Timi and Grace Scales in Patients Living in the North With Acute Coronary Syndrome

Кожокарь¹,

Урванцева²,

Лифшиц³

et al. 2017

Journal of Clinical Practice

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The aim of our research is to study associations of psychosocial factors with the probable hospital mortality according to the TIMI and Grace scales in patients with acute coronary syndrome living in the North. Materials and methods. 269 patients (female n = 57, n = 212 men) with acute coronary syndrome were examined, their average age was 56,0 ± 6,1 years (45-64 years). The complex of diagnostic studies and surveys of patients on a specially designed questionnaire consisting of general questions, the «AUDIT» test and the assessment of the psychological state of the individual was accomplished. An assessment of the severity of the coronary lesion on the SYNTAX scale was conducted; the calculation of the estimated hospital mortality rate on the TIMI and Grace scales was performed.Results. Male gender is associated with the development of alexithymia in a group of patients with a low and moderate risk of a possible hospital mortality rate on the Grace scale (r = 0.20, p <0.01). Continuance of residence in the North is associated with the development of myocardial infarction (r= 0.18, p <0.01) in the group of people with a low and moderate risk of probable hospital mortality. The direct associations of nonconventional factors with high risk of hospital-related mortality on the Grace scale in patients with acute coronary syndrome are high personal levels (OR = 1.593, 95% CI 1.373- 1.943, p = 0.027) and situational anxiety (OR = 1.728, 95% CI 1.037 -2.881, p = 0.036). The leading factors determining the severity of coronary artery disease on the SYNTAX scale in the group of patients with the high risk of possible hospital mortality according to the Grace scale are the low level of social integration (OR = 0.205, 95% CI 0.043-0.394, p = 0.012) and satisfaction with social support ( OR = 0.714, 95% CI 0.546-0.935, p = 0.014). Personal anxiety is associated with an increase in the incidence of alexithymia in high-risk patients for the probable hospital mortality rate on the TIMI scale (r = 0.40, p <0.01). Determining factors of the high risk of the probable hospital mortality on the TIMI scale are: the time from the moment of the onset of the pain syndrome to the admission of the patient to the hospital (OR = 0.580, 95% CI 0.338-0.995, p = 0.048) and low ejection fraction (OR = 0.930, 95% CI 0.875-0.988, p = 0.019).Conclusion. Directly determining nonconventional factors of high risk of possible hospital mortality on the Grace scale in patients with acute coronary syndrome living in the North are high levels of personal and situational anxiety. The age of patients and the continuance of stay in the North in patients with acute coronary syndrome do not significantly affect the level of probable hospital mortality on the Grace scale. The combination of indicators of long-term residence in the North and significant coronary bed lesion on the SYNTAX scale determine a high risk of a possible hospital mortality rate on the TIMI scale in patients with acute coronary syndrome.

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Risk Scores After Acute Coronary Syndrome

Cited by 10 publications

References 49 publications

Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease

Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease

A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort

Associations of Psychosocial Factors With Probable Hospital Mortality According to the Timi and Grace Scales in Patients Living in the North With Acute Coronary Syndrome

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