| Objective:Acute coronary syndromes,including unstable angina(UA)and non ST segment elevation myocardial infarction(NSTEMI),and ST segment elevation myocardial infarction(STEMI),reflect process of a series of clinical pathophysiological of acute myocardial ischemia.It is a group of acute myocardial ischemia syndrome that is caused by the rupture of unstable atherosclerotic plaques in the coronary artery,which leads to the formation of thrombosis and blocks the blood vessels partially or completely.The rates of its complications and case fatality are high,and its harm to human's health is extremely great,especially the high-risk patients.They may occur Cardiac arrest,heart failure,cardiac death and so on.Therefore,rapid and accurate diagnosis,early risk stratification and different interventions are of great clinical significance for reducing the incidence of MACE and improving the prognosis of patients.The Global Acute Coronary Events Registry(GRACE)score is a predictive tool designed to assess long-term mortality or MACE of ACS patients during hospitalization and after discharge.Studies have shown that GRACE score can distinguish the ACS patients with high-risk and low-risk patients,predict the rate of in-hospital mortality and the incidence of MACE of ACS patients,and it is a good tool to evaluate long-term prognosis of ACS patients.But the study found that GRACE risk score still has shortcomings.In recent years,there have been many studies that improved the GRACE score,for example,some studies found that Coronary angiography,erythrocyte fatty acid levels,resting respiration rate,plasma N-terminal pro-brain natriuretic peptide and low fetuin A may improve the lack of judgment of prognosis of ACS patients with GRACE score.White blood cell count in peripheral blood is the cell that is the earliest applied to reflect the inflammation.Numerous studies have demonstrated the inflammation plays an important role in the occurrence and development of atherosclerotic plaque.Although,the white blood cell count is a non-specific inflammatory indicator,it can be a quick and reliable evaluation index in risk stratification of ACS patients,and it can be regarded as one of the important factors in the evaluation of prognosis of acute coronary syndrome.This study aimed to improved the value of GRACE score for the evaluation of the long-term prognosis with ACS.Methods: 284 ACS patients,who were,from the heart internal medicine of the first affiliated hospital of Chengde Medical University,were selected,during December 2014 to September 2015.Finally,248 cases were selected,and the other 36 patients were excluded,because of data loss or lost.The patients included 128 cases of UA,50 cases of NSTEMI and 70 cases of STEMI.According to the GRACE score on admission of patients,patients were divided into three groups:low-risk group,the moderate group and high-risk group;according to the level of WBC,the patients were divided into two groups:higher group and normal group;according to the occurrence of MACE are divided into the event group and event free group.The observational indicator is the MACE,including UA,AMI,cardiac arrest,heart failure and Cardiac death,etc.The chi-square test of fourfold table data and row Ścolumn datawas used to analyze the incidence of MACE in groups;the non parametric test was used to compare the data between event group and event free group;the correlation analysis was used to analyze the correlation of GRACE score with the WBC.Results:1 The comparison of GRACEscore among the three groups of MACE.The incidence of MACE of low risk group was 27.2%,the incidence of MACE of the moderate was 34.6%,and the incidence of MACE of high-risk group was 64.7%.The incidence of MACE of high risk group was significantly higher than those of the other two groups,and had statistical significance(P<0.05).The incidences of MACE among the three groups were compared,the difference between the incidences of MACE in low-risk group and high-risk group had statistical significance(P<0.0125),the incidence of MACE in high-risk group was significantly higher than that of low-risk group;the difference between the incidences of MACE in the moderate group and high-risk group had statistical significance(P<0.0125),the incidence of MACE in high-risk group was significantly higher than that of moderate group;but the difference between the incidences of MACE in the moderate group and low-risk group didn't had statistical significance(P>0.0125).2 A comparison between the incidences of MACE in WBC elevated group and WBC normal group.The incidence of MACE of Elevated WBC group was 50.7%,the incidence of MACE of the WBC normal group was 27.7%.The incidence of MACE of the Elevated WBC group was significantly higher than the WBC normal group's.The difference between the incidences of MACE of the two group had statistical significance(P<0.05).3 A comparison between the GRACE high-risk along with WBC elevated group and the sample.The incidence of MACE of the former was 88.0%,The incidence of MACE of the latter was 34.7%.The difference between the incidences of MACE of the two group had statistical significance(P<0.05).4 A comparison between the GRACE high-risk along with WBC elevated group and the GRACE high-risk group.The incidence of MACE of the former was 88.0%,The incidence of MACE of the latter was 64.7%.The difference between the incidences of MACE of the two group had statistical significance(P<0.05).5 A comparison between the GRACE high-risk along with WBC elevated group and the WBC elevated group.The incidence of MACE of the former was 88.0%,The incidence of MACE of the latter was 50.7%.The difference between the incidences of MACE of the two group had statistical significance(P<0.05).6 A comparison between the event group and event free group.The difference of the GRACE score and WBC level between the two groups had statistical significance(P<0.05).7 The analysis of GRACE score and WBC correlation.The two-variable scatter plot was used to show that the two had positive correlation.The normality test was used,but the two variables were not subject to normal distribution,so spearman correlation analysis was used to analyze the relationship between the two variables.It had shown that the two variables had positive correlation,the correlation coefficient was 0.548(P<0.05).Conclusion:1 The GRACE risk score can distinguish the high-risk and low-risk patients with acute coronary syndrome perfectly and evaluate the condition.Prognosis and outcome of patients with ACS,which can provide effective basis for the doctor's treatment plan and judgment prognosis.2 White blood cell count level can also provide reference for the doctor's treatment plan and judgment prognosis.3 GRACE score and WBC can be used as evaluation index of outcomes of patients with ACS as well.However,Using the two methods at the same time can evaluate the prognosis of patients with ACS better. |
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