Prognostic Value Of Lipoprotein-associated Phospholipase A₂ Testing And GRACE Score In Patients With Acute Coronany Syndrome

Objective To explore the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2) level obtained on admission and global registry of acute coronary events(GRACE) scores and the value for risk stratification in patients with acute coronary syndrome(ACS).Methods A total of 206 patients diagnosed ACS and coronary angiography(CAG) was performed in TEDA International Cardiovascular Hospital between April 2014 and July 2014 were followed up to 30 days,including 34 patients with unstable angina(UA), 53 patients with non-ST-segment elevation myocardial infarction(NSTEMI) and 119 ST-segment elevation myocardial infarction(STEMI). Admission plasma Lp-PLA2 was measured in all patients in one hour before CAG. The GRACE risk score were used for risk assessment. Endpoints included death, reinfaretion, recurrent, ischemia and new onset of congestive heart failure.Results According to GRACE risk stratification, lg Lp-PLA2 level on admission inereased in proportion to increasing risk defined by GRACE risk stratification.The GRACE risk score was the highest in the fourth Lp-PLA2 quartile(P<0.00 l VS.1owest, second and third quartiles). GRACE score was significantly higher in patients with Lp-PLA2 leve1 above the 75 percentile compared patients with Lp-PLA2 leve1 under the 75 percentile(P<0.001). The Lp-PLA2 level positively correlated with GRACE risk score(r=0.717, P=0.000) in ACS patients. During the follow up, 25 endpoints(12.1%) were recorded including 2 deaths(1.0%), 13 recurrent ischemia(6.3%), 4 reinfaretion(1.94%) and 6 new onset of congestive heart failure(5.3%). The lg Lp-PLA2(2.277±0.200) was significantly higher in the endpoints group than in non-endpoints group(2.607±0.173)(P<0.001). The GRACE score [251.00(208.50, 289.50) point] was significantly higher in the endpoints group than in non-endpoints group [134.00(107.178.00) point]( P<0.001). The prognostic criteria for Lp-PLA2 levelwas 288.64ng/m L determined by ROC(under cure: 0.901, 95%CI: 0.841~0.960, P=0.000). For GRACE score, the predictive value for endpoints was 0.929(95%CI: 0.884~0.974, P=0.000) and thecut-off point was 182 points. In the logistic regression model, Lp-PLA2 concentration( > 288.64ng/ml, OR=7.060, P < 0.05) and GRACE score(>182 points, OR=17.335, P<0.05) were independent predictors of endpoints in patients with ACS.Conclusion Lp-PLA2 levels at admission were positively correlated with the GRACE score in ACS patients. Both Lp-PLA2 level at admission and GRACE score were independent predictors for endpoints at 30 days in patients with ACS.Admission Lp-PLA2 levels need to reach a certain threshold to show differences in predicting the prognosis for 30 days in patients with ACS. Lp-PLA2> 288.64ng/ml, GRAC> 182 points, BNP> 311ng/L, high fibrinogen are risk factors for 30 d endpoint events in ACS.