Document Detail

Improving long-term risk prediction in patients with acute chest pain: the Global Registry of Acute Coronary Events (GRACE) risk score is enhanced by selected nonnecrosis biomarkers.
MedLine Citation:
PMID:  20598977     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome. However, there is limited knowledge regarding the utility of this score for long-term risk prediction in unselected patients with acute chest pain and whether it might be improved by the integration of nonnecrosis biomarkers. METHODS: We calculated the GRACE risk score in 453 chest pain patients and assessed its value for risk assessment together with the additive prognostic information obtained from N-terminal pro-B-type natriuretic peptide, C-reactive protein, growth differentiation factor-15 (GDF-15), and cystatin C. RESULTS: After a median follow-up of 5.8 years, 92 patients (20.7%) had died. The GRACE risk score was significantly higher in patients who died (median 146 vs 93, P < .001) and provided a c-statistic regarding mortality of 0.78. A significant increase of the c-statistic was achieved only after addition of GDF-15 (c-statistic 0.81, P = .003) and, to a minor extent, after addition of cystatin C (c-statistic 0.81, P = .035). Assessment of the integrated discriminative improvement yielded similar results. N-terminal pro-B-type natriuretic peptide had only limited incremental prognostic value, and C-reactive protein was not predictive for outcome. CONCLUSION: The GRACE risk score allows for the prediction of mortality in chest pain patients even after almost 6 years of follow-up. However, its predictive value could be further enhanced by the addition of selected nonnecrosis biomarkers, in particular GDF-15 or cystatin C.
Kai M Eggers; Tibor Kempf; Per Venge; Lars Wallentin; Kai C Wollert; Bertil Lindahl
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  88-94     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
Department of Medical Sciences, Cardiology, Uppsala University Hospital and Uppsala Clinical Research Center, Uppsala, Sweden.
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MeSH Terms
Acute Coronary Syndrome / blood,  complications*,  epidemiology
Aged, 80 and over
Biological Markers / blood
C-Reactive Protein / metabolism*
Chest Pain / diagnosis*,  epidemiology,  etiology
Coronary Care Units
Disease Progression
Follow-Up Studies
Growth Differentiation Factor 15 / blood
Middle Aged
Natriuretic Peptide, Brain / blood*
Necrosis / blood
Peptide Fragments / blood*
Protein Precursors
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Salivary Cystatins / blood
Severity of Illness Index
Sweden / epidemiology
Time Factors
Troponin I / blood*
Reg. No./Substance:
0/Biological Markers; 0/Growth Differentiation Factor 15; 0/Peptide Fragments; 0/Protein Precursors; 0/Salivary Cystatins; 0/Troponin I; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein

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