Clinical Study Of Predictive Value Of ALP Combined With GRACE Score In The Short-term Prognosis Of Patients With ACS

Objective:At present,acute coronary syndrome(ACS)is still a serious challenge in the cardiovascular field.Therefore,it is of great significance to find clinical indicators that can be used for early diagnosis of ACS patients,assessment of disease severity,risk stratification and predicting prognosis.In recent years,many studies have shown that serum alkaline phosphatase(ALP)was independent predictor of cardiovascular diseases risk and prognosis.GRACE score is a commonly used scoring system for risk stratification and predicting prognosis in ACS patients.It has high sensitivity and specificity,but there are still some limitations due to the limited factors of GRACE score.In this study,we focused on the correlation between serum ALP level,GRACE score,and the severity of coronary artery disease in patients with ACS,We aslo assessed the predictive value of serum ALP level,GRACE score,and the combination of the two for the short-term(6 months)prognosis of ACS patients.We aim to provide some help in better assessing the risk stratification and prognosis of ACS patients.Methods:A total of 229 patients with ACS who were admitted to the Department of Cardiology of the Second Hospital of Jilin University from October 2016 to June 2017 were included in the ACS group.In the same period,61 patients with normal coronary confirmed by artery angiography or coronary artery CTA were selected as the control group.The information of all the selected patients was collected,including general data,laboratory blood biochemical tests,electrocardiogram and other results.GRACE score and serum ALP level were recorded for all selected patients.Reviewing coronary angiography results,patients in ACS group were further divided into single-vessel disease group,double-vessel disease group,and triple-vessel disease group.According to SYNTAX scores,patients in ACS group were divided into mild,moderate,and severe coronary lesions.All selected ACS patients were followed for 6 months and were divided into event group and non-event group according to the occurrence of major adverse cardiovascular events(MACEs).The levels of serum ALP and GRACE score were compared in different groups.Spearman correlation analysis was used to investigate the correlation between ALP,GRACE score and coronary artery lesions in ACS patients.Multivariate logistic regression analysis was used to analyze the risk factors for MACE events.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of the ALP,GRACE score and the combination of both on the short-term prognosis of ACS patients.Results:1.Compared with the control group,serum ALP levels and GRACE scores were significantly increased in the ACS group,the differences were statistically significant(all P<0.01).Multivariate logistic regression analysis showed that serum ALP and GRACE scores were independent risk factors for ACS patients.2.The serum ALP level in triple-vessel disease group was higher than that in double-vessel disease group(P < 0.05)and single-vessel disease group(P <0.05).The GRACE score in triple-vessel disease group was higher than that in single-vessel disease group(P<0.05).The levels of the serum ALP and the GRACE score in severe group(SYNTAX score)were higher than those in moderate group(all P<0.05)and mild group(all P<0.05).The levels of the serum ALP and the GRACE score in moderate group were higher than those in mild group(all P<0.05).The ALP was positively correlated with the number of lesion vessels(r=0.329,P<0.01)and the SYNTAX scores(r=0.407,P<0.01).The GRACE score was positively correlated with the number of lesion vessels(r=0.204,P<0.01)and the SYNTAX scores(r=0.416,P<0.01).Further study showed that the ALP was positively correlated with GRACE score(r=0.225,P<0.01).3.A total of 229 ACS patients,in which 16 were lost,were followed up for 6 months.There were 35 patients with MACEs(16.43%),including cardiac mortality in 3 cases(1.41%),hospitalization for angina or heart failure in 24 cases(11.26%),non-fatal myocardial infarction in 3 cases(1.41%)and target blood vessel revascularization in 5 cases(2.35%).Serum ALP levels and GRACE scores in the event group were significantly higher than those in the non-event group(all P<0.01).Multivariate logistic regression analysis showed that age,ALP and GRACE score were independent risk factors for the short-term prognosis of ACS patients.4.Analysis of ROC curves: the area under the curve of ALP was 0.671(95% CI 0.574-0.768),and the best cutoff value was 95.5 U/L.The sensitivity and specificity were 65.7% and 65.2%,respectively.The area under the GRACE score was 0.764(95% CI 0.698-0.830).The best cutoff value was 128.5 points.The sensitivity and specificity were 77.1% and 70.2 %,respectively.The area under the ROC curve of ALP combined with GRACE score was 0.800(95% CI 0.724-0.876),and the best cutoff value was 0.163211.The sensitivity and specificity were 79.2% and 74.7%,respectively.Conclusion:1.Serum ALP levels and GRACE scores in the ACS group were higher than those in the control group.2.Serum ALP levels,GRACE scores were positively correlated with coronary artery lesions in patients with ACS.3.Serum ALP levels and GRACE scores can be used as predictors of MACE events in patients with ACS in the near future(6 months).4.The combination of serum ALP levels and GRACE scores has higher predicting accuracy about the short-term prognosis of ACS patients.