Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: The MADDEC study

Nina Syyli (Corresponding Author), Hautamäki Markus, Kari Antila, Shadi Mahdiani, Markku Eskola, Terho Lehtimäki, Kjell Nikus, Leo-Pekka Lyytikäinen, Niku Oksala, Jussi Hernesniemi

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015-2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong's method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.

Original languageEnglish
Article numbere001007
Pages (from-to)e001007
JournalOpen Heart
Volume6
Issue number1
DOIs
Publication statusPublished - 1 Jun 2019
MoE publication typeA1 Journal article-refereed

Fingerprint

Acute Coronary Syndrome
Stroke Volume
Registries
Mortality
Coronary Angiography
Regression Analysis

Keywords

  • acute coronary syndrome
  • left ventricular ejection fraction
  • mortality
  • prediction

Cite this

Syyli, Nina ; Markus, Hautamäki ; Antila, Kari ; Mahdiani, Shadi ; Eskola, Markku ; Lehtimäki, Terho ; Nikus, Kjell ; Lyytikäinen, Leo-Pekka ; Oksala, Niku ; Hernesniemi, Jussi. / Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS : The MADDEC study. In: Open Heart. 2019 ; Vol. 6, No. 1. pp. e001007.
@article{c7aa10990c2a48358c43cd4a8bc63de9,
title = "Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: The MADDEC study",
abstract = "Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015-2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong's method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95{\%} CI 1.030 to 1.042; LVEF: HR: 0.965, 95{\%} CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95{\%} CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95{\%} CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95{\%} CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.",
keywords = "acute coronary syndrome, left ventricular ejection fraction, mortality, prediction",
author = "Nina Syyli and Hautam{\"a}ki Markus and Kari Antila and Shadi Mahdiani and Markku Eskola and Terho Lehtim{\"a}ki and Kjell Nikus and Leo-Pekka Lyytik{\"a}inen and Niku Oksala and Jussi Hernesniemi",
year = "2019",
month = "6",
day = "1",
doi = "10.1136/openhrt-2019-001007",
language = "English",
volume = "6",
pages = "e001007",
journal = "Open Heart",
issn = "2053-3624",
publisher = "BMJ Publishing Group",
number = "1",

}

Syyli, N, Markus, H, Antila, K, Mahdiani, S, Eskola, M, Lehtimäki, T, Nikus, K, Lyytikäinen, L-P, Oksala, N & Hernesniemi, J 2019, 'Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: The MADDEC study', Open Heart, vol. 6, no. 1, e001007, pp. e001007. https://doi.org/10.1136/openhrt-2019-001007

Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS : The MADDEC study. / Syyli, Nina (Corresponding Author); Markus, Hautamäki; Antila, Kari; Mahdiani, Shadi; Eskola, Markku; Lehtimäki, Terho; Nikus, Kjell; Lyytikäinen, Leo-Pekka; Oksala, Niku; Hernesniemi, Jussi.

In: Open Heart, Vol. 6, No. 1, e001007, 01.06.2019, p. e001007.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS

T2 - The MADDEC study

AU - Syyli, Nina

AU - Markus, Hautamäki

AU - Antila, Kari

AU - Mahdiani, Shadi

AU - Eskola, Markku

AU - Lehtimäki, Terho

AU - Nikus, Kjell

AU - Lyytikäinen, Leo-Pekka

AU - Oksala, Niku

AU - Hernesniemi, Jussi

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015-2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong's method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.

AB - Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015-2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong's method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.

KW - acute coronary syndrome

KW - left ventricular ejection fraction

KW - mortality

KW - prediction

UR - http://www.scopus.com/inward/record.url?scp=85068867128&partnerID=8YFLogxK

U2 - 10.1136/openhrt-2019-001007

DO - 10.1136/openhrt-2019-001007

M3 - Article

C2 - 31328004

VL - 6

SP - e001007

JO - Open Heart

JF - Open Heart

SN - 2053-3624

IS - 1

M1 - e001007

ER -