The Application Of GRACE Score In The Prognosis Of ACS Patients In Hospital

Objective:The purpose of this study was to estimate the value of global acute coronary event registry(GRACE score)in the prognosis of patients with acute coronary syndrome in hospital,as the yanan university affiliated hospital of single-center study data,to the emergency department and the cardiologist about ACS patients with nosocomial judgment provides the basis of the risk score,to improve the Opportunities for diagnosis and treatment,and more conducive to the center of the chest pain standardization construction.Methods:From November 2017 to October 2018,about 254 patients with acute coronary syndrome who met the standard were collected from the cardiovascular and cerebrovascular hospital affiliated to yan 'an university.Based on whether significant adverse cardiovascular events occurred during hospitalization,the hospital prognosis of patients was determined.Patients were divided into the occurrence group of cardiovascular events and the non-occurrence group,and the basic clinical data of the two groups were compared.According to the GRACE scoring system,each patient meeting the inclusion criteria was given a score.Patients in the three groups of low,middle and high risk levels were obtained according to the scores,and the in-hospital prognosis of patients at different levels was compared.Independent risk factors in the hospital of patients with acute coronary syndrome were analyzed by Logistic regression.ROC curve was used to evaluate the predictive value of GRACE scoring system for the risk of major adverse cardiovascular events during hospitalization in patients with acute coronary syndrome and the optimal critical value for the evaluation.Results:1.In this study,a total of 254 patients,aged 37-94 years,with an average age of58.24�10.76 years were included,including 149 male patients(58.66%)and 105 female patients(41.34%).The GRACE scores of ACS patients with MACE duringhospitalization were significantly higher than those without MACE(128.55 �67.34vs89.87�42.94),and the difference was statistically significant(P<0.05).The area under the curve of GRACE risk scoring system in assessing the prognosis of ACS patients in hospital is greater than 0.7(AUC=0.915),which means that this scoring system has a high value in judging the prognosis of ACS patients in hospital.2.The higher the cardiac function score(Killp)of patients with acute coronary syndrome at admission,the higher the incidence of MACE during hospitalization;The incidence of MACE was higher(66.67%,85.71%)in patients with grade III and IV cardiac function during hospitalization.In addition,there were statistically significant differences in the incidence of MACE between the four grades of cardiac function(P<0.05).3.The higher the GRACE risk score of patients with acute coronary syndrome on admission,the higher the incidence of major cardiovascular events during hospitalization.;The incidence of MACE was the highest in high-risk group(67.92%).The occurrence of MACE was compared between the low,medium and high risk levels of GRACE risk score,and the difference was statistically significant(P <0.05).4.Comparison of general clinical data between groups with and without major cardiovascular events,the difference was statistically significant are: age,heart rate,systolic blood pressure,creatinine,CK-MB,NT-proBNP and grade of cardiac function(Killp),gender,history of hyperlipidemia,hypertension,coronary heart disease family history,smoking history,pre-hospital cardiac arrest,GRACE grade,length of hospital stay.5.The results of multivariate Logistic regression showed that the main independent risk factors of adverse cardiovascular events in patients with acute coronary syndrome during hospitalization were gender,age,heart rate,systolic blood pressure,creatinine,ck-mb,nt-probnp,hyperlipidemia,hypertension,smoking history,cardiac arrest before hospitalization,and GRACE score.6.According to ROC curve analysis,the optimal diagnostic threshold for GRACE score to predict major adverse cardiovascular events in patients with acute coronary syndrome during hospitalization is 136 points or 137 points(when GRACE score is136.5,the scoring system has a better sensitivity and specificity to predict MACE risk in ACS patients during hospitalization,AUC=0.915,95%CI: 0.881-0.949,P<0.01).Conclusion:1.GRACE score has a high predictive value for the prognosis of patients with acute coronary syndrome in hospital.The higher GRACE score is,the higher the probability of adverse cardiovascular events in hospital will be.2.When GRACE score is 136 or 137,it has a good sensitivity and specificity for the occurrence of major cardiovascular events in patients with acute coronary syndrome in hospital.3.Age,gender,blood creatinine,heart rate,CK-MB,NT-proBNP,history of hypertension,hyperlipidemia,smoking history,pre-hospital cardiac arrest and GRACE score of patients with acute coronary syndrome are independent risk factors for MACE risk during hospitalization.