| Objective: To investigate the prognostic value of growth factor-15 complements the GRACE score in patients with non-ST-segment elevation acute coronary syndrome.Methods:According to the inclusion criteria,73 Non-ST elevated acute coronary syndrome patients(experimental group)confirmed by coronary angiography and 37 hospitalized patients(matched for age,sex,height and weight as the normal control group)confirmed with normal coronary arteries were enrolled in this study from Chizhou City People's Hospital in June 2015-June 2016.The level of serum GDF-15 was measured by Enzyme-Linked Immunosorbent Assay(ELISA)on admission,and then calculate the score of Global Registry of Acute Coronary Events.The levels of serum GDF-15 and GRACE score in the experimental group and the control group were compared.N-terminal pro-brain natriuretic peptide(NTpro BNP)was a discrete variable,and the natural logarithm of NTpro BNP(In NTpro BNP)followed the normal distribution,and left ventricular ejection and In NTpro BNP were compared,other clinical basic data and blood biochemical data were compared too.The correlation between serum GDF-15 level and clinical data such as GRACE score,In NTpro BNP and LVEF in NSTE-ACS patients were analyzed by pearson correlation analysis.NSTE-ACS patients were followed up for six months,recorded within six months of major adverse cardiovascular events.Results:(1)Compared the NSTE-ACS group with control group in measurement data: A total of 110 hospitalized patients were enrolled in this study.Among them,73 patients were included in the NSTE-ACS group(including non-ST elevation myocardial infarction patients and unstable angina patients),37 patients were included in the normal control group,There were no significant differences in age,systolic blood pressure,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,uric acid and hemoglobin(p > 0.05).the LVEF in NSTE-ACS patients was significantly lower than that in the control group(p <0.01).The In NTpro BNP,the serum creatinine the and the level of serum GDF-15 of NSTE-ACS patients were significantly higher than that in the control group(p <0.01),the differences were statistically significant.The GRACE risk scores of patients in the NSTE-ACS group were(100.720±23.790)scores.(2)Compared the NSTE-ACS patients with the control group in the attribute data: In this study,a total of 68 patients with ST-segment deviation,including NSTE-ACS group of 51 patients,the control group of 17 cases.In the NSTE-ACS group,the proportion of patients with ST-segment change and the number of people with smoking were significantly higher than those of the control group(p <0.05).There was no significant difference in the history of drinking history,diabetes mellitus(DM),coronary heart disease,the number of patients with the elevated myocardial markers and the proportion of male patients among the NSTE-ACS patients group(p > 0.05).(3)Correlation between serum GDF-15 levels and blood biochemical parameters and other clinical data with NSTE-ACS patients : Pearson correlation analysis showed that the serum GDF-15 levels of NSTE-ACS patients were positively correlated with GRACE risk score(r = 0.576,p <0.001),In NTpro BNP(r = 0.602,p <0.001)and creatinine(r = 0.286,p =0.003),and negatively correlated with left ventricular ejection fraction(r =-0.608,p<0.001).There were no significant correlations between TC,TG,HDL,LDL and hemoglobin(p> 0.05).(4)Evaluation of serum GDF-15 level and GRACE score in the diagnosis of prognosis of NSTE-ACS patients:In this study,NSTE-ACS patients were followed up for six months,recorded in the six months of MACE,a total of 73 cases of NSTE-ACS patients completed follow-up.The total of MACE were 26 cases,including 1 case of death,1 case of myocardial infarction and 23 cases of recurrent angina pectoris.The area under the curve of MACE in NSTE-ACS patients predicted by the level of serum GDF-15 was 0.862,(95%CI:0.773,0.951)with the operator's characteristic curve;the sensitivity was 84.60%,and the specificity was 85.10%;The area under the curve of MACE in NSTE-ACS patients predicted by GRACE score was 0.813,(95%CI:0.712,0.914);the sensitivity was 69.20%,and the specificity was 85.10%;The Serum GDF-15 levels combined with GRACE score increased the area under the curve of MACE in NSTE-ACS patients from 0.862 in serum GDF-15 to 0.873(95%CI:0.790,0.956),the difference was statistically significant(p <0.05).(5)Univariate and multivariate logistic regression analysis: Defined NSTE-ACS patients with adverse cardiovascular events as the dependent variable,the variables that may affect the prognosis of NSTE-ACS patients were included in univariate and multivariate logistic regression analysis,the results showed serum GDF-15 level,GRACE score,LVEF,In NTpro BNP,age and the ST segment changs were risk factors used to predict the prognosis of NSTE-ACS patients(p <0.05).Moreover,serum GDF-15 level was the independent risk factor used to predict the short-time prognosis of NSTE-ACS patients after adjusting other risk factors(p <0.05).Conclusions1.There was a positive correlation between the serum GDF-15 level and GRACE score in NSTE-ACS group;2.The Serum levels of GDF-15 have a high diagnostic value for the prognosis of patients with NSTE-ACS;3.Combined serum GDF-15 levels and GRACE scores increased the diagnosis value of the prognosis of patients with NSTE-ACS compared with the serum GDF-15 levels or GRACE score alone;4.The Serum GDF-15 levels was an independent risk factor for the prognosis of NSTE-ACS patients after adjustment for other risk factors. |
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