A Study On The Value Of GRACE Risk Score United With NT-proBNP As A Predictor For The Prediction Of Early Mortality In Patients With Acute Coronary Syndrome

Objective: Acute coronary syndrome(ACS)was a serious one in coronary heart diseases for its high mortality and disability rate, so it's significant to effectively predict the mortality. Though both the GRACE risk scores and NT-proBNP could predict the early mortality (30 days) in patients with ACS, ti's still not clear that whether NT-proBNP united with GRACE risk scores can predict the early mortality. In order to improve the ability of predicting the early mortality and making the risk stratification accurately and rapidly, we retrospectively reviewed the general condition and influencing factors of the early mortality of 462 inpatients with ACS, respectively analysed the effect of GRACE risk scores and NT-proBNP on the early mortality, and also judged the effect when combinated the twomethods.Methods: 462 inpatients with ACS were studied. Drawn blood within 24 hours after the onset of chest pain, measured the plasma concentration of NT-proBNP and determined the patients'GRACE risk score. Statistically analysed the effect of predicting the early mortality by NT-proBNP levels united with GRACE risk scores.Results:1.The influencing factors about the early cardiovascular disease (CVD) mortality of patients with ACS :The CVD early mortality was 13.90%(n=64)in 462 cases. The advanced age, AMI, hypercholeslerolemia, smoking, cardiac arrest when hospitalized, STEMI, cardiac markers higher than the normal, higher LDL-C, NT-proBNP lever at a high value and high GRACE risk scores were the independent risk factors for the improved early mortality;β-Blockers and ACEI/ARB were the protective factors for ACS.2. The effect of GRACE risk score and 24 hours NT-proBNP lever on early mortality: The Cox model displayed that the GRACE risk score and NT-proBNP level both were the predictors of the improved early mortality (NT-proBNP,1.758[95%CI, 1.226-2.522], P=0.002;and GRACE risk scores,1.015[95%CI, 1.010-1.020], P<0.001), and the 24 hours NT-proBNP lever, which was independent of the other indexes in GRACE risk scores, was also a high-risk warning index for early mortality(NT-proBNP , 1.491[95%CI, 1.017-2.185],P=0.041).The Kaplan-Meier survivorship curve showed that patients who were equal or greater than the mean of GRACE risk scores had lower early mortality than that under the GRACE risk score mean(Log rank14.86,P<0.001).3. The effect of GRACE score united with NT-proBNP on the risk prediction for early mortality: Applied the receiver operating characterist (ROC) curve to analyse the area under the curve (AUC), NT-proBNP'AUC was higher than that of GRACE risk scores (NT-proBNP,0.796, P<0.001;and GRACE risk scores,0.751 ,P<0.001),and the combination of GRACE scores and NT-proBNP had the highest AUC, 0.800 (P<0.001).Conclusion: Measuring the plasma concentration of NT-proBNP within 24 hours after the onset of ACS is better than the GRACE risk score in predicting early mortality. The combination of GRACE score and NT-proBNP can improve the risk prediction for early mortality.