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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Can imaging improve the GRACE risk score accuracy?
Session:
Posters 5 - Écran 1 - Doença Coronária
Speaker:
Diana De Campos
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Diana Decampos; Carolina Saleiro; Rogerio Teixeira; João Lopes; Joana M. Ribeiro; Luís Puga; José Pedro Sousa; Ana Botelho; Carolina Lourenço; Lino Gonçalves
Abstract
<p>BACKGROUND: Both interventricular septum thickness (IST) and Global Registry of Acute Coronary Events (GRACE) score have moderate predictive value for mortality in patients with ST-segment elevation myocardial infarction (STEMI). The prognostic significance of combined GRACE score and IST remains unclear.</p> <p>METHODS: A total of 303 consecutive patients admitted for STEMI in a single center coronary intensive unit with evaluation of both GRACE score and IST were included. Six-month all-cause mortality was analyzed. A univariate analysis was done to identify if both GRACE score and IST were predictors of the endpoint. Then they were entered in a multivariate Cox regression model. Receiver operating characteristic (ROC) analysis was used to determine the ability of the GRACE score and IST to distinguish patients with and without the event. The ROC curve of combined indicator (GRACE score + IST) was acquired through binary logistic regression analysis followed by ROC analysis. The respective areas under the curve (AUCs) and 95% confidence interval (CI) were calculated and differences were tested by the DeLong equality test. The cutoff value of each predictive model was derived from the Youden index.</p> <p>RESULTS: During the 6-month follow-up, 14 patients (4.6%) met the endpoint. Patients who died until the 6<sup>th</sup>month had higher GRACE score (179.9±29.5 vs 150.7±37.6, <em>P</em><0.01) and higher IST (11.9±1.6 vs. 10.4±2.0,<em>P</em><001). Multivariate Cox analysis showed that both IST (HR 1.317; 95%CI 1.048-1.654; <em>P</em>=0.018) and GRACE score (HR 1.017; 95%CI 1.004-1.030; <em>P</em>=0.010) were independently associated with 6-month mortality. GRACE score had an AUC of 0.735 (<em>P</em><0.001) and the associated criterion was 149 points. IST had an AUC of 0.742 (<em>P</em><0.001) and the associated criterion was 11mm. Adding IST on top of the GRACE score yielded superior risk predictive capacity, which is shown by improved c-statistic value (0.84, <em>P </em>value for improvement=0.0298).</p> <p>CONCLUSION: According to our data, in patients with STEMI, a simple imaging variable, septum thickness can increase the accuracy of the classic GRACE risk score.</p>
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