Comparison Of GRACE Score And ACEF Score In Predicting Long-term Prognosis Of Patients With Acute Coronary Syndromes Treated With PCI

Objective: This study was conducted to compare the predictive value of global registry of acute coronary events(GRACE)and age,creatinine,and ejection fraction score(ACEF)in patients with acute coronary syndrome(ACS)treated with percutaneous coronary intervention(PCI).Methods: In this study,patients admitted to the First Hospital of Lanzhou University between March 2017 and December 2018 were collected.These patients were clearly diagnosed with ACS and were treated with percutaneous coronary intervention.A total of 1197 patients were enrolled,and all of them completed 2-year follow-up.According to the occurrence of all-cause death as the main end point event during the follow-up period,they were divided into the death group(94 cases)and the survival group(1103 cases).According to the occurrence of major cardiovascular cerebrovascular adverse events(MACCES)as the secondary end points during the follow-up period,they were divided into the MACCEs group(197 cases)and the nonMACCEs group(1000 cases).MACCEs including recurrent myocardial infarction,advanced revascularization,readmission to hospital for severe heart failure,and ischemic stroke.GRACE risk score and ACEF risk score were calculated.Multiple Cox regression analysis was used to identify independent risk factors for all-cause mortality in patients with ACS.Receiver operating characteristic curve(ROC)was drawn,and the Area Under curve(AUC)of Grace score and ACEF score was compared.The life table method was used for survival analysis.Results:1.Clinical features: Compared with women,ACS patients are more likely to be male.However,more patients in the low-risk group of GRACE and low-risk group of ACEF are male and women are more likely to be in the medium or high risk of GRACE,and medium or high groups of ACEF.Compared with patients in the low-risk of GRACE group and the low-risk of ACEF group,patients in the high-risk of GRACE group and the high-risk of ACEF group are older,the higher the rate of complicated hypertension,diabetes,ischemic stroke,heart failure,and previous myocardial infarction,the more complex the coronary artery lesions,and the worse the cardiac function.2.Multivariate Cox regression analysis: GRACE score and ACEF score are independent risk factors for all-cause mortality of ACS patients within 2 years follow up(P < 0.05).Each 1-point increase in GRACE score was associated with a 1.006-fold increased risk of death(95%CI: 1.003 to 1.008);Each 1-point increase in ACEF score was associated with a 3.292-fold increased risk of death(95%CI: 2.028 to 5.344).3.ROC curve analysis: The AUC for all-cause death in ACS patients evaluated by GRACE score within 2 years was 0.759(95%CI: 0.754-0.783),and the AUC for MACCES events was 0.693(95%CI: 0.611-0.667).The AUC for all-cause death in ACS patients evaluated by ACEF score within 2 years was 0.726(95%CI: 0.700-0.751)and 0.634(95%CI: 0.605-0.661)for MACCES events.These results indicated that GRACE score and ACEF score have predictive value on all-cause death and MACCES events for ACS patients who receives PCI treatment(P < 0.05).GRACE score and ACEF score had similar predictive power between the occurrence of all-cause death and MACCES events(P > 0.05).4.Survival analysis: All 1197 ACS patients completed follow-up,7.8% of whom had an all-cause death and 16.4% had a MACCES event.The cumulative risk of allcause death and MACCES within 2 years in the high-risk GRACE group was significantly higher than that in the low-risk and medium-risk groups,and the higher the risk stratification was,the higher the cumulative risk of all-cause death and MACCES was.There was statistical difference in pairwise comparison between groups(P < 0.05).The cumulative risk of all-cause death and MACCES within 2 years in patients with high ACEF score was significantly higher than that in patients with low and intermediate ACEF score,and the higher the risk stratification was,the higher the cumulative risk of all-cause death and MACCES was.There was statistical difference in pairwise comparison between groups(P < 0.05).Conclusion: GRACE score and ACEF score have similar predictive value for allcause death and MACCES in patients with ACS within 2 years.