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Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes

George, Anish; John, Joseph; Sathyapalan, Thozhukat; Chattopadhyay, Sudipta

Authors

Anish George

Joseph John

Sudipta Chattopadhyay



Abstract

Aims Global Registry of Acute Coronary Events (GRACE) risk score (GRS), a powerful predictor of prognosis after ACE, does not include a glucometabolic measure. We investigate whether 2 hour post-load plasma glucose (2h-PG) could improve GRS based prognostic models in ACE patients without known diabetes mellitus (DM). Methods Retrospective cohort study of 1056 ACE survivors without known DM who had fasting (FPG) and 2h-PG measured pre-discharge. Death and non-fatal myocardial infarction (MI) were recorded as major adverse cardiac events (MACE) during follow up. GRS for discharge to 6 months was calculated. Cox proportional-hazards regression was used to identify predictors of event free survival. The predictive value of 2h-PG alone and combined with GRS was estimated using Likelihood ratio test, Akaike's Information criteria, continuous net reclassification improvement (NRI>0) and integrated discrimination improvement (IDI). Results During 40.8 months follow up 235 MACEs (22.3%) occurred, more frequently in the upper 2h-PG quartiles. 2h-PG, but not FPG, adjusted for GRS independently predicted MACE (HR 1.091; 95 % CI 1.043-1.142; p=0.0002). Likelihood ratio test showed that 2h-PG significantly improved the prognostic models including GRS (χ2=20.56, 1 df, p=0.000). Models containing GRS and 2h-PG yielded lowest corrected Akaike's Information criteria, compared to that with only GRS. 2h-PG, when added to GRS, improved net reclassification significantly (NRIe>0 6.4%, NRIne>0 24%, NRI>0 0.176, p = 0.017 at final follow up). 2h-PG, improved integrated discrimination of models containing GRS (IDI of 0.87%, p=0.008 at final follow up). Conclusion Two-hour PG, but not FPG, is an independent predictor of adverse outcome after ACE even after adjusting for the GRS. Two-hour PG, but not FPG, improves the predictability of prognostic models containing GRS.

Citation

George, A., John, J., Sathyapalan, T., & Chattopadhyay, S. (2018). Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes. European Heart Journal, 39(29), 2740-2745. https://doi.org/10.1093/eurheartj/ehy233

Journal Article Type Article
Acceptance Date Apr 6, 2018
Online Publication Date Apr 26, 2018
Publication Date Aug 1, 2018
Deposit Date Apr 8, 2018
Publicly Available Date Oct 27, 2022
Print ISSN 0195-668X
Electronic ISSN 1522-9645
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 39
Issue 29
Pages 2740-2745
DOI https://doi.org/10.1093/eurheartj/ehy233
Keywords Acute coronary syndrome; Myocardial infarction; GRACE; Global Registry of Acute Coronary Events; Prognosis; Diabetes; Oral glucose tolerance
Public URL https://hull-repository.worktribe.com/output/772503
Publisher URL https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehy233/4986947