The Predictive Value Of D-dimer And GRACE Score For Long-term HF In AMI Patients

Objective:To explore the predictive value of D-dimer（D-D）and Global Register of Acute Coronary Events（GRACE）score in patients with acute myocardial infarction（AMI）for long-term heart failure,and the combined predictive value of the two indexes.Methods:A retrospective analysis was performed in 400 patients diagnosed with AMI in The Department of Cardiology,Affiliated Hospital of Yangzhou University from January 2016 to December 2018.According to the occurrence of long-term HF,AMI patients were divided into HF group and non-HF group,and the baseline data and D-D and GRACE score of the two groups were observed.Then,patients were divided into high D-D group and low D-D group based on the median of D-D,and the baseline data and long-term HF occurrence of patients in the two groups were observed.Univariate and Multivariate Cox regression analysis was used to explore the risk factors of long-term HF,so as to clarify the potential relationship between D-D and GRACE score and long-term HF in patients with AMI.Meanwhile,the correlation between D-D and GRACE score was analyzed.The time-dependent ROC curve was used to analyze D-D and GRACE score and their combined predictive value for long-term HF.Patients were divided into three groups according to D-D and GRACE score:low value group,intermediate group,and high value group,The occurrence of long-term HF in the three groups was analyzed by Kaplan-Meier survival curve.Results:1.The AMI patients were divided into HF group and non-HF group according to the occurrence of long-term HF.The D-D[0.5（0.3,0.8）VS 0.2（0.1,0.3）,P<0.01)]and GRACE score（177.2±26.9 VS 134.2±27.0,P<0.01）in the HF group were higher than those in the non-HF group.2.Based on the median of D-D（0.3mg/L）,AMI patients were divided into two groups:high D-D group and low D-D group,the GRACE score（168.9±30.6 VS 136.6±29.8,P<0.01）and the incidence of HF（62.9%VS 18.5%,P<0.01）in the high DD group was higher than that in the low DD group.3.Multivariate Cox regression analysis showed that higher D-D（HR=1.475,95%CI:1.243-1.750,P<0.01）,GRACE score（HR=1.025,95%CI:1.018-1.032,P<0.01）,and the history of hypertension（HR=1.885,95%CI:1.306-2.719,P=0.001）,Diabetes mellitus（HR=1.743,95%CI:1.228-2.473,P=0.002）,smoking（HR=1.574,95%CI:1.105-2.243,P=0.012）were independently associated with long-term HF in patients with AMI,and that higher Left ventricular ejection fraction（LVEF）（HR=0.966,95%CI:0.950-0.982,P<0.01）was a protective factor for the occurrence of long-term HF in patients with AMI.4.Spearman analysis showed that D-D was positively correlated with GRACE scores（r=0.508,P<0.01）,but negatively correlated with LVEF（r=-0.324,p<0.01）.5.Time-dependent ROC curve showed that both D-D and GRACE score had predictive value for the occurrence of post-infarct HF.Specific:Both of them had the same predictive value for the occurrence of HF at 12 months and 48 months after AMI（P>0.05）,but GRACE score was more powerful in predicting the occurrence of HF at 24 months,36 months and 60 months after AMI（P<0.05）,among which,GRACE score had the strongest ability to predict the occurrence of HF at 60 months after AMI,and the area under the curve（AUC）was 0.985（P<0.05）.However,the combined predictive value of the two indicators did not improve further from the value of AUC alone.6.Kaplan-Meier survival curve analysis showed that the incidence of long-term HF was higher in the high D-D group than in the low D-D group（P<0.01）.Similarly,the incidence of long-term HF was higher in the high GRACE group than in the low GRACE group（P<0.01）.Further study found that the high value group（high D-D and GRACE score）had the highest long-term HF incidence,while the low value group（low D-D and GRACE score）had the lowest long-term HF incidence（P<0.01）.Conclusion:1.Compared with AMI patients without HF,D-D and GRACE score were significantly higher in patients with long-term HF at admission to AMI.2.Patients with AMI with high D-D level at admission were 3.4 times more likely to develop long-term HF than patients with low D-D level.3.High D-D level,GRACE score,and prior hypertension,diabetes,and smoking history were independent risk factors for long-term HF,while high LVEF was a protective factor for long-term HF.4.D-D was positively correlated with GRACE scores.Both had predictive value for the occurrence of HF at 5 years after AMI,but GRACE score had stronger ability to predict the occurrence of HF at 24,36 and 60 months after AMI.5.Although the combined prediction ability of D-D and GRACE score for long-term HF after AMI was not improved compared with that of single index,patients with high D-D and GRACE scores were high-risk groups for long-term HF.