To Investigate The Optimal Timing Of Intervention In Patients With Non-st-segment Elevation Myocardial Infarction At High Risk Of GRACE Score Based On Hs-cTn Calculation

Background:With the improvement of people’s material living standards,the impact of unhealthy habits such as poor diet and lack of exercise on people’s health is also increasing.China has become a large country with cardiovascular disease(CVD).Among them,the number of people suffering from non-ST-segment elevation myocardial infarction(NSTEMI)is also increasing year by year.The disease is characterized by rapid disease progression,uncertain prognosis,and complications;it poses a serious threat to the life safety of patients and a serious burden to the health and economy of the population.In confirmed NSTEMI,high-sensitivity troponin(hs-cTn)is widely used as the preferred choice in clinical practice.Also among the many prediction models to assess patient risk,the GRACE risk score has the best predictive power.《2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation》state that early(<24h)percutaneous coronary intervention(PCI)is the most effective treatment for patients with a GRACE score >140,which can rapidly open the offender’s vessel and restore blood flow to the ischemic myocardium,reperfusion.However,most current GRACE risk scores are calculated based on CK-MB or conventional troponin.The use of modern hs-cTn to detect and calculate GRACE risk scores is not emphasized.Therefore,the optimal timing of the calculated GRACE risk score >140 to guide invasive coronary angiography(ICA)and revascularization remains undetermined.Objective:To investigate the differences in endpoint outcome events among different intervention timing in NSTEMI patients with a high risk of GRACE risk score(>140 points)based on hs-cTn calculation.To investigate the optimal timing of PCI intervention for such patients and to determine whether early intervention is still recommended for NSTEMI patients at high risk of GRACE risk score based on hs-cTn and to guide clinical management.Methods:This study included 223 patients who were admitted to the cardiovascular medicine departments of Subei People’s Hospital and Taizhou People’s Hospital from May 1,2018,to December 31,2020,with a diagnosis of NSTEMI and a high risk of GRACE risk score based on hs-cTn calculation,and treated with PCI.General information of patients was collected,including gender,age,height,weight,previous medical history,smoking history,hypertension history,diabetes history,pacemaker history,atrial fibrillation history;basic in-hospital information: i.e.heart rate at admission,systolic blood pressure,Killip classification of cardiac function,whether ST-segment deviation,whether there was cardiac arrest at admission,hs-cTn I(ultrasensitive troponin I),NT-proBNP(amino-terminal brain natriuretic peptide precursor),creatinine,time from admission to PCI,and the presence of triple lesions.Based on the collected data,a GRACE risk score was performed on the patients,and patients with a GRACE score>140 and undergoing PCI were included in the subjects.According to the timing of intervention,patients were divided into the early intervention group(n=80)(<24h)and the delayed intervention group(n=143)(> 24h).The primary endpoint events,including all-cause death and adverse cardiovascular and cerebrovascular events(MACCE),and secondary endpoints,including nonfatal myocardial infarction(recurrent STEMI,NSTEMI),revascularization [including coronary artery bypass grafting(CABG),PCI],stroke,hospitalization for recurrent angina or heart failure,embolism,and bleeding,were recorded during the follow-up period of 730 d.and bleeding.The general clinical data,laboratory tests,and the incidence of endpoint events were compared between the two groups,and the risk factors or protective factors for the endpoint events were analyzed.Results:1.comparing the baseline data of the two groups,there were no statistically significant differences between the two groups in terms of gender,age,BMI,history of smoking,history of hypertension,history of diabetes,and history of pacemaker(P > 0.05).There was no statistically significant difference between the two groups in terms of serological data on admission immediately,heart rate(beats/min)as well as systolic blood pressure at admission(mm Hg),creatinine(umol/L),hs-cTn I(ng/ml),NT-ProBNP(ug/L),and cardiac function Killip classification(P > 0.05).2.Comparing the endpoint events of the two groups,the all-cause mortality,MACCE incidence,and stroke incidence in the early intervention group were 4(5.00%),21(26.25%),and 4(5%),respectively.The rates of all-cause mortality,MACCE,and stroke in the deferred intervention group were 27(18.88%),62(43.36%),and 21(14.69%),respectively;the differences were significant(P < 0.05).In contrast,there were no statistically significant differences in the endpoint events of heart failure rehospitalization rate,infarction rehospitalization rate,angina rehospitalization,embolism,and bleeding rate(P > 0.05).3.MACCE logistic regression analysis showed that early intervention was an independent protective factor for MACCE(OR=0.48,95% CI: 0.25 to 0.90,P =0.022);age was an independent risk factor for MACCE(OR=1.05,95% CI: 1.01 to 1.09,P=0.015);NT-ProBNP was an independent risk factor for MACCE(OR=1.12,95% CI:1.09 to 1.19,P =0.043).The results of the Cox proportional risk regression model for all-cause mortality showed that early intervention was an independent protective factor for all-cause mortality(HR=0.277,95% CI: 0.095 to 0.809,P =0.019);age was an independent risk factor for all-cause mortality(HR=1.061,95% CI: 1.008 to 1.117,P=0.023);the BMI was an independent risk factor for all-cause mortality(HR=1.020,95% CI: 1.009 to 1.031,P <0.001);Kaplan-Meier survival curves comparing the two groups for all-cause mortality revealed that all-cause mortality was significantly lower in the early intervention group than in the delayed intervention group(HR=3.935,95%CI: 1.898 to 8.169,P log rank=0.006).Conclusions.1.Early intervention is an independent protective factor for all-cause mortality and MACCE in patients with NSTEMI at high risk of GRACE score calculated based on hs-cTn.The early intervention resulted in significant reductions in all-cause mortality,MACCE incidence and stroke incidence.2.Early intervention is recommended for patients with NSTEMI at high risk of GRACE score based on hs-cTn.