Download PDF
Thromb Haemost 2021; 121(03): 297-308
DOI: 10.1055/s-0040-1718411
Coagulation and Fibrinolysis

A Novel ABC Score Predicts Mortality in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Who underwent Percutaneous Coronary Intervention

Ying-Ying Zheng‡   *
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Ting-Ting Wu‡   *
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Ying Gao   *
4   Cadre Ward, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Qian-Qian Guo
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Yan-Yan Ma
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jian-Chao Zhang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Yi-Li Xun
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Ding-Yu Wang
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Ying Pan
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Meng-Die Cheng
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Feng-Hua Song
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Zhi-Yu Liu
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Kai Wang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Li-Zhu Jiang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Lei Fan
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Xiao-Ting Yue
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Yan Bai
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Zeng-Lei Zhang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Xin-Ya Dai
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Ru-Jie Zheng
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
You Chen
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Xiang Ma
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Yi-Tong Ma
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jin-Ying Zhang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2   Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Xiang Xie
3   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
› Author Affiliations Funding This research was funded by Xinjiang Science and Technology Aid Project (2019E0278), Tianshan Xuesong Project (2018XS17), China Postdoctoral Foundation (2019M652593) and Postdoctoral Research Grant Foundation in Henan Province (1902006).
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective In the present study, we aimed to establish a novel score to predict long-term mortality of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI).

Methods A total of 2,174 NSTE-ACS patients from the CORFCHD-ZZ study were enrolled as the derivation cohort. The validation cohort including 1,808 NSTE-ACS patients were from the CORFCHD-PCI study. Receiver operating characteristic analysis and area under the curve (AUC) evaluation were used to select the candidate variables. The model performance was validated internally and externally. The primary outcome was cardiac mortality (CM). We also explored the model performance for all-cause mortality (ACM).

Results Initially, 28 risk factors were selected and ranked according to their AUC values. Finally, we selected age, N-terminal pro-B-type natriuretic peptide, and creatinine to develop a novel prediction model named “ABC” model. The ABC model had a high discriminatory ability for both CM (C-index: 0.774, p < 0.001) and ACM (C-index: 0.758, p < 0.001) in the derivation cohort. In the validation cohort, the C-index of CM was 0.802 (p < 0.001) and that of ACM was 0.797 (p < 0.001), which suggested good discrimination. In addition, this model had adequate calibration in both the derivation and validation cohorts. Furthermore, the ABC score outperformed the GRACE score to predict mortality in NSTE-ACS patients who underwent PCI.

Conclusion In the present study, we developed and validated a novel model to predict mortality in patients with NSTE-ACS who underwent PCI. This model can be used as a credible tool for risk assessment and management of NSTE-ACS after PCI.

Keywords

non-ST-segment elevation acute coronary syndrome - prediction model - all-cause mortality - cardiac mortality - percutaneous coronary intervention - creatinine - N-terminal pro-B-type natriuretic peptide

* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 20 July 2020

Accepted: 31 August 2020

Article published online:
31 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 D'Ascenzo F, Iannaccone M, Saint-Hilary G. et al. Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. Eur Heart J 2017; 38 (42) 3160-3172
    CrossrefPubMedSearch in Google Scholar
  • 2 Golwala HB, Cannon CP, Steg PG. et al. Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials. Eur Heart J 2018; 39 (19) 1726-1735a
    CrossrefPubMedSearch in Google Scholar
  • 3 Poldervaart JM, Langedijk M, Backus BE. et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017; 227: 656-661
    CrossrefPubMedSearch in Google Scholar
  • 4 Sharp AL, Wu YL, Shen E. et al. The HEART score for suspected acute coronary syndrome in U.S. emergency departments. J Am Coll Cardiol 2018; 72 (15) 1875-1877
    CrossrefPubMedSearch in Google Scholar
  • 5 Hall M, Bebb OJ, Dondo TB. et al. Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction. Eur Heart J 2018; 39 (42) 3798-3806
    CrossrefPubMedSearch in Google Scholar
  • 6 Cerqueira Junior AMDS, Pereira LGDS, Souza TMB. et al. Prognostic accuracy of the GRACE score in octogenarians and nonagenarians with acute coronary syndromes. Arq Bras Cardiol 2018; 110 (01) 24-29
    PubMedSearch in Google Scholar
  • 7 Baeza-Román A, de Miguel-Balsa E, Latour-Pérez J, Carrillo-López A. Predictive power of the grace score in population with diabetes. Int J Cardiol 2017; 248: 73-76
    CrossrefPubMedSearch in Google Scholar
  • 8 Thalib L, Furuya-Kanamori L, AlHabib KF. et al. Validation of the 6-month GRACE score in predicting 1-year mortality of patients with acute coronary syndrome admitted to the Arabian Gulf hospitals. Angiology 2017; 68 (03) 251-256
    CrossrefPubMedSearch in Google Scholar
  • 9 McAllister DA, Halbesma N, Carruthers K, Denvir M, Fox KA. GRACE score predicts heart failure admission following acute coronary syndrome. Eur Heart J Acute Cardiovasc Care 2015; 4 (02) 165-171
    CrossrefPubMedSearch in Google Scholar
  • 10 Luo JG, Yang M, Han L, Jia X, Chen LW, Zhao Y. Validity of the GRACE score for 6-month death or reinfarction after presentation with acute myocardial infarction in patients 80 years of age and older. Coron Artery Dis 2013; 24 (07) 537-541
    CrossrefPubMedSearch in Google Scholar
  • 11 Reindl M, Reinstadler SJ, Tiller C. et al. ACEF score adapted to ST-elevation myocardial infarction patients: the ACEF-STEMI score. Int J Cardiol 2018; 264: 18-24
    CrossrefPubMedSearch in Google Scholar
  • 12 Pelliccia F, Gaudio C. The ACEF score in patients undergoing percutaneous coronary intervention: “Keep it simple and focus on what matters”. Int J Cardiol 2019; 286: 54-55
    CrossrefPubMedSearch in Google Scholar
  • 13 Schellings DA, Adiyaman A, Dambrink JE. et al. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores. Vasc Health Risk Manag 2016; 12: 471-476
    CrossrefPubMedSearch in Google Scholar
  • 14 Klingenberg R, Aghlmandi S, Räber L. et al. Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score. Eur Heart J Acute Cardiovasc Care 2018; 7 (02) 129-138
    CrossrefPubMedSearch in Google Scholar
  • 15 Zhang C, Jiang L, Xu L. et al. Implications of N-terminal pro-B-type natriuretic peptide in patients with three-vessel disease. Eur Heart J 2019; 40 (41) 3397-3405
    CrossrefPubMedSearch in Google Scholar
  • 16 He PC, Duan CY, Liu YH, Wei XB, Lin SG. N-terminal pro-brain natriuretic peptide improves the C-ACS risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction. BMC Cardiovasc Disord 2016; 16 (01) 255
    CrossrefPubMedSearch in Google Scholar
  • 17 Zheng YY, Wu TT, Chen Y. et al. Gamma-glutamyl transferase-to-platelet ratio as a novel predictor of long-term adverse outcomes in patients after undergoing percutaneous coronary intervention: a retrospective cohort study. Thromb Haemost 2019; 119 (06) 1021-1030
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Zheng YY, Wu TT, Chen Y. et al. Resting heart rate and long-term outcomes in patients with percutaneous coronary intervention: results from a 10-year follow-up of the CORFCHD-PCI study. Cardiol Res Pract 2019; 2019: 5432076
    CrossrefPubMedSearch in Google Scholar
  • 19 Hartaigh B, Gransar H, Callister T. et al. Calcium Scoring. Development and validation of a simple-to-use nomogram for predicting 5-, 10-, and 15-year survival in asymptomatic adults undergoing coronary artery calcium scoring. JACC Cardiovasc Imaging 2018; 11 (03) 450-458
    CrossrefPubMedSearch in Google Scholar
  • 20 Syyli N, Hautamäki M, Antila K. et al. Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study. Open Heart 2019; 6 (01) e001007
    CrossrefPubMedSearch in Google Scholar
  • 21 Shuvy M, Klein E, Cohen T, Shlomo N, Rozenbaum Z, Pereg D. Value of adding the CHA2DS2-VASc score to the GRACE score for mortality risk prediction in patients with acute coronary syndrome. Am J Cardiol 2019; 123 (11) 1751-1756
    CrossrefPubMedSearch in Google Scholar
  • 22 Moady G, Iakobishvili Z, Beigel R. et al. The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome. J Cardiol 2019; 73 (04) 271-275
    CrossrefPubMedSearch in Google Scholar
  • 23 Chattopadhyay S, George A, John J, Sathyapalan T. Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes. Eur Heart J 2018; 39 (29) 2740-2745
    CrossrefPubMedSearch in Google Scholar
  • 24 Cordero A, Rodriguez-Manero M, García-Acuña JM. et al. Additive value of the CRUSADE score to the GRACE score for mortality risk prediction in patients with acute coronary syndromes. Int J Cardiol 2017; 245: 1-5
    CrossrefPubMedSearch in Google Scholar
  • 25 Camelo-Castillo A, Rivera-Caravaca JM, Marín F, Vicente V, Lip GYH, Roldán V. Predicting adverse events beyond stroke and bleeding with the ABC-stroke and ABC-bleeding scores in patients with atrial fibrillation: the Murcia AF project. Thromb Haemost 2020; 120 (08) 1200-1207
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Esteve-Pastor MA, Roldán V, Rivera-Caravaca JM, Ramírez-Macías I, Lip GYH, Marín F. The use of biomarkers in clinical management guidelines: a critical appraisal. Thromb Haemost 2019; 119 (12) 1901-1919
    Thieme ConnectPubMedSearch in Google Scholar