Predictive Value Of Discharge Grace Score Combined With Serum NT-ProBNP For Mace Within Six Months Of CHIP-ACS

OBJECTIVE: the predictive value of discharge GRACE score combined with serum NT-Pro BNP level in the occurrence of MACE within 6 months after discharge from CHIP complicated with ACS.METHODS: check the records of patients who underwent coronary angiography in the cardiac catheterization operation room of the First Affiliated Hospital of Guangxi Medical University from October 1,2018 to September 30,2020,and initially screen the coronary angiograms for CHIP cases and collect them using the hospital HIS system Among them,the clinical data of 129 CHIP patients with coronary heart disease were included.After inclusion and exclusion criteria,a total of 81 eligible cases were finally included.According to whether MACE occurred within 6 months after discharge,they were divided into MACE group(n=28)and non-MACE group(n=53).The baseline data,serum NT-Pro BNP levels and GRACE scores of the two groups of patients before discharge were statistically analyzed.The value of the discharge GRACE score combined with serum NT-Pro BNP level in predicting the occurrence of MACE in CHIP complicated by ACS was compared with the area under the receiver operating characteristic curve(ROC curve).RESULTS: there was no statistically significant difference in gender,heart rate at discharge,systolic blood pressure at discharge,history of smoking,history of drinking,previous hypertension,previous cerebrovascular disease,previous diabetes,CK-MB,STEMI,NSTEMI,MACE group and non-MACE group(P>0.05).The differences in age,serum creatinine,past chronic renal insufficiency,and UA were statistically significant(P<0.05).The difference between the degree of CHIP coronary artery disease and whether the coronary artery revascularization is between the MACE group and the non-MACE group.Among them,unprotected left main stem disease,revascularization(P<0.05)are statistically significant,three-vessel disease,CTO disease,and original In-stent restenosis ≥50% was not statistically significant(all P>0.05).The GRACE score of patients in the MACE group was 151.18±32.60 points at discharge,and the non-MACE group was 109.64±29.14 points.There was a statistical difference between the two groups(P<0.001).Discharged GRACE risk stratification MACE group has 0 cases of low risk accounting for 0%,4 cases of intermediate risk accounting for 17.6%,24 cases of high risk accounting for 82.4%,16 cases of non-MACE group low risk accounting for 24.4%,and 17 cases of intermediate risk Accounted for 40.0%,20 high-risk cases accounted for 35.6%,the difference between the two groups was statistically significant(P<0.05).The NT-Pro BNP level(pg/ml)of patients in the MACE group at discharge was7205.0(1410.75-25760.0),and that of the non-MACE group was 1846.0(547.55-6059.0).There was a statistical difference between the two groups(P=0.002).The logistic binary regression OR(95% CI)of discharge GRACE score and serum NT-Pro BNP level were 1.041(1.018～1.064)and 1.00065(1.0003 ～ 1.0012),respectively,P<0.05.Both are risk factors for MACE.According to receiver operating characteristic curve(ROC curve)analysis,the area under the ROC curve(AUC)of the discharged GRACE score is 0.828,the AUC of the serum NT-Pro BNP level is 0.709,and the AUC of the discharged GRACE score combined with the serum NT-Pro BNP level is 0.863(P<0.05).95%CI : 0.740 ～ 0.916vs0.585 ～ 0.833vs0.781 ～ 0.944.The GRACE score for judging the best cut-off value is 114 points,NT-Pro BNPis6887ng/ml,and its Youden index is 0.4946vs0.4036vs0.5674;sensitivity is 92.86%vs53.57%vs64.29%;specificity is respectively56.60%vs86.79%vs92.45%;the positive predictive value was 53.1vs53.3vs81.8;the negative predictive value was 93.7vs80.9vs83.1;the positive likelihood ratio was 2.14vs3.03vs8.52;the negative likelihood ratio is 0.13vs0.63vs0.39.Conclusion: the discharge GRACE score and serum NT-Pro BNP level can predict the occurrence of MACE in CHIP complicated by ACS within six months.The GRACE score of 114 points and the NT-Pro BNP level of6887ng/ml increase the probability of MACE occurrence.The sensitivity and specificity are 92.86% vs 56.60,respectively.%,53.57% vs 86.79%.The predictive value of the combination of the two is higher than that of a single factor.