Long-term predictive value of high-sensitivity C reactive protein combined with Global Registered Acute Coronary Events risk score for predicting incidence of major adverse cardiovascular events in patients with ST segment elevation acute myocardial infar
Yang Xinmiao
Jin Zening
Li Hong
Pu Lianmei
Chen Hui
Wang Fan
Abstract：Objective To evaluate the long-term predictive value of high-sensitivity C reactive protein (hs-CRP) combined with Global Registered Acute Coronary Events (GRACE) risk score predicting incidence of major adverse cardiovascular events (MACE) in patients with ST segment elevation acute myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).Methods A total of 298 patients diagnosed of STEMI and treated with PCI were included from January 2009 to June 2010 in Beijing Anzhen Hospital.The patients were divided into event group (n =116) with MACE after 2-year follow-up and control group (n =173) without MACE after 2-year follow-up.The clinical baseline data,serum level of hs-CRP and GRACE risk score were recorded on admission.The incidence of MACE after PCI was analyzed after 2-year follow-up.Multivariable logistic regression was used to screen the independent predictors of long-term MACE and a predictor [Lβ (Y)] combined by GRACE risk score; hs-CRP was established using logistic regression model.The receiver operating characteristic (ROC) curve for predicting MACE was drawn and the area under the curve (AUC) of GRACE risk score,hs-CRP and [Lβ(Y)] was assessed.Risk stratify was done according to GRACE risk score combined with hs-CRP.Results During 2-year follow-up,there were 289 cases with complete data and 9 cases were lost with a dropout rate of 3.1％.In event group,the ratio of left ventricular ejection fraction (LVEF) ＜45％ [17.2％ (20/116)],serum leve of hs-CRP [14.9 (11.7,18.9) mg/L],top troponin [90.9 (45.7,189.8) μg/L] and GRACE risk score [(127 ± 21)] were all significantly different from those in control group [ratio of LVEF ＜ 45％:6.9％(12/173),hs-CRP:8.9 (8.1,10.2) mg/L,top troponin:64.9 (38.4,132.5) μg/L,GRACE risk score:(101 ± 20)] (all P ＜ 0.05).With the increase of hs-CRP level,the incidence of MACE was increased according to the quartiles of hs-CRP; the incidence of MACE was 15.9％ (10/63),26.3％ (22/84),49.3％(37/75) and 70.1％(47/67) in Q1,Q2,Q3 and Q4 group,respectively,with significantly differences between Q3,Q4 group and Q1 group (P ＜0.05).The incidence of MACE was 14.4％ (14/97) in patients with low-risk of GRACE risk score,significantly lower than that in patients with moderate risk [41.4％ (41/99)] and high risk [76.3％ (71/93)] (both P ＜ 0.05).hs-CRP was an independent predictor for long-term MACE with adjusted odds rates of 1.166 (95％ CI:1.092-1.246,P ＜ 0.01).The AUC of Lβ (Y) was 0.887 (95％ CI:0.845-0.921),higher than that of GRACE risk score and hs-CRP (0.887 vs 0.809,P =0.000 3,0.887 vs 0.846,P =0.017 7,respectively).Combined with GRACE risk score and hs-CRP,the risk stratification was improved in patients with moderate-risk of GRACE risk score.Conclusions Hs-CRP is an independent predictor for long-term MACE in patients with STEMI after treatment of PCI,which can improve the detection rate of MACE in high-risk patients combined with GRACE risk score.
Keywords：Acute myocardial infractionHigh-sensitivity C reactive proteinThe global registered acute coronary events risk scoreLong-term prognostic
Publication Date：2015-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 300-304 )