The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction
Background: The Global Registry of Acute Coronary Events (GRACE) score is a powerful tool used to predict in-hospital mortality after acute myocardial infarction (AMI) and does not include a glycometabolism-related index. We investigated whether the addition of the stress hyperglycemia ratio (SHR) p...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Hellenic Journal of Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966622001865 |
| _version_ | 1827977272800313344 |
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| author | Qiang Chen Hong Su Xiuqiong Yu Yingzhong Chen Xunshi Ding Bo Xiong Chunbin Wang Long Xia Tao Ye Kai Lan Jun Hou Shiqiang Xiong Lin Cai |
| author_facet | Qiang Chen Hong Su Xiuqiong Yu Yingzhong Chen Xunshi Ding Bo Xiong Chunbin Wang Long Xia Tao Ye Kai Lan Jun Hou Shiqiang Xiong Lin Cai |
| author_sort | Qiang Chen |
| collection | DOAJ |
| description | Background: The Global Registry of Acute Coronary Events (GRACE) score is a powerful tool used to predict in-hospital mortality after acute myocardial infarction (AMI) and does not include a glycometabolism-related index. We investigated whether the addition of the stress hyperglycemia ratio (SHR) provides incremental prognostic value in addition to the GRACE score. Methods: A retrospective cohort of 613 AMI patients was enrolled in the present analyses. The patients were stratified according to the primary endpoint (in-hospital mortality) and the tertiles of the SHR. Results: During hospitalization, 40 patients reached the primary endpoint, which was more frequently observed in patients with a higher SHR. The SHR, but not admission blood glucose (ABG), adjusted for the GRACE score independently predicted in-hospital mortality [odds ratio 2.5861; 95% confidence interval (CI), 1.3910–4.8080; P = 0.0027]. The adjustment of the GRACE score by the SHR improved the predictive ability for in-hospital death (an increase in the C-statistic value from 0.787 to 0.814; net reclassification improvement, 0.6717, 95% CI 0.3665–0.977, P < 0.01; integrated discrimination improvement, 0.028, 95% CI 0.0066–0.0493, P = 0.01028). The likelihood ratio test showed that the SHR significantly improved the prognostic models, including the GRACE score. Adding the SHR to the GRACE score presented a larger net benefit across the range of in-hospital mortality risk than the GRACE score alone. Conclusion: The SHR, but not the ABG, is an independent predictor of in-hospital mortality after AMI even after adjusting for the GRACE score. The SHR improves the predictability and clinical usefulness of prognostic models containing the GRACE score. |
| first_indexed | 2024-04-09T21:01:12Z |
| format | Article |
| id | doaj.art-cae08aa5f9bd41c8bcd0d784e2393ef7 |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-04-09T21:01:12Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-cae08aa5f9bd41c8bcd0d784e2393ef72023-03-29T09:25:12ZengElsevierHellenic Journal of Cardiology1109-96662023-03-01703645The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarctionQiang Chen0Hong Su1Xiuqiong Yu2Yingzhong Chen3Xunshi Ding4Bo Xiong5Chunbin Wang6Long Xia7Tao Ye8Kai Lan9Jun Hou10Shiqiang Xiong11Lin Cai12From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaFrom Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaCorresponding authors.; From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaCorresponding authors.; From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, ChinaBackground: The Global Registry of Acute Coronary Events (GRACE) score is a powerful tool used to predict in-hospital mortality after acute myocardial infarction (AMI) and does not include a glycometabolism-related index. We investigated whether the addition of the stress hyperglycemia ratio (SHR) provides incremental prognostic value in addition to the GRACE score. Methods: A retrospective cohort of 613 AMI patients was enrolled in the present analyses. The patients were stratified according to the primary endpoint (in-hospital mortality) and the tertiles of the SHR. Results: During hospitalization, 40 patients reached the primary endpoint, which was more frequently observed in patients with a higher SHR. The SHR, but not admission blood glucose (ABG), adjusted for the GRACE score independently predicted in-hospital mortality [odds ratio 2.5861; 95% confidence interval (CI), 1.3910–4.8080; P = 0.0027]. The adjustment of the GRACE score by the SHR improved the predictive ability for in-hospital death (an increase in the C-statistic value from 0.787 to 0.814; net reclassification improvement, 0.6717, 95% CI 0.3665–0.977, P < 0.01; integrated discrimination improvement, 0.028, 95% CI 0.0066–0.0493, P = 0.01028). The likelihood ratio test showed that the SHR significantly improved the prognostic models, including the GRACE score. Adding the SHR to the GRACE score presented a larger net benefit across the range of in-hospital mortality risk than the GRACE score alone. Conclusion: The SHR, but not the ABG, is an independent predictor of in-hospital mortality after AMI even after adjusting for the GRACE score. The SHR improves the predictability and clinical usefulness of prognostic models containing the GRACE score.http://www.sciencedirect.com/science/article/pii/S1109966622001865acute myocardial infarctionGRACE scorestress hyperglycemia ratioadmission blood glucosein-hospital mortality |
| spellingShingle | Qiang Chen Hong Su Xiuqiong Yu Yingzhong Chen Xunshi Ding Bo Xiong Chunbin Wang Long Xia Tao Ye Kai Lan Jun Hou Shiqiang Xiong Lin Cai The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction Hellenic Journal of Cardiology acute myocardial infarction GRACE score stress hyperglycemia ratio admission blood glucose in-hospital mortality |
| title | The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction |
| title_full | The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction |
| title_fullStr | The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction |
| title_full_unstemmed | The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction |
| title_short | The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction |
| title_sort | stress hyperglycemia ratio improves the predictive ability of the grace score for in hospital mortality in patients with acute myocardial infarction |
| topic | acute myocardial infarction GRACE score stress hyperglycemia ratio admission blood glucose in-hospital mortality |
| url | http://www.sciencedirect.com/science/article/pii/S1109966622001865 |
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