| Background and ObjectiveCardiovascular disease is the leading cause of death among the world,and has killed a much larger amount of people every year than any other disease has.Therefore,patients with coronary atherosclerosis diseases(CAD)require a further improvement in diagnosis,treatment,prevention and control.With the advancement in diagnosis and treatment methods nowadays,the evaluation of disease outcomes has become extremely significant.GRACE risk score,originating from Global Registry of Acute Coronary Events,aims at providing potent evaluation system for risk.However,GRACE risk score has been currently under great disputation over prediction efficacy for it’s established 2 decades before.On the other hand,several clinical surveys suggest that prognosis of percutaneous coronary intervention(PCI)is significantly influenced by factors like diabetes mellitus,Glycosylated Hemoglobin A1c,fasting blood-glucose and Chronic total occlusion(CTO).Apparently,these factors are not included in calculating GRACE risk score and we’ll going to find out whether they will serve as an efficient complement for GRACE risk score in predicting Major Adverse Cardiac and Cerebrovascular Event(MACCE)6 months and 1 year after discharge.Meanwhile,our research will elaborate the predictive value of several combined diagnoses on the outcome ensue from different revascularization methods.Data and Methods:1.Clinical Data320 patients with CAD who were admitted at Department of Cardiology of Shandong Provincial Hospital from January 2018 to February 2019 and received PCI therapy was enrolled in our research.Mean age was 63 years;224(70.0%)patients were male;121(37.8%)patients had Diabetes Mellitus;141(44.1%)of them receive complete revascularization;During 6-month and 1-year follow up 54(16.9%)and 111(34.7%)MACCE occurred respectively.2.Methods2.1 Clinical Data Acquirement and Follow-upAll patients enrolled underwent a comprehensive inquiry about medical history and thoroughly physical examination.After admission,electrocardiogram and echocardiography were performed.Follow by the exclusion of any known contraindications,cardiac angiograms were obtained to identify the coronary artery lesions.Blood sample was acquired for laboratory examination.After hospital discharge,the telephone-based interview occurred at the 6th month and 1 year.The major end point is the occurrence of MACCE outside the hospital.2.2 Statistical AnalysisWe use SPSS 26.0 statistical software.The categorical variables are expressed as a percentage(%),the chi-square test is used for the comparison between the two groups,and the normal distribution of the measurement data is expressed as the mean±standard deviation(X±S).The measurement data of the non-normal distribution is expressed by the median(interquartile range),and the data comparison between the two groups is performed by the Mann-Whitney U test.Correlation analysis between normal distribution continuous variables uses Pearson correlation analysis.Correlation analysis between non-normal distribution continuous data and categorical data uses Spearman’s correlation analysis.Correlation analysis between normal distribution continuous data and binary classification data correlation is performed by point biserial correlation analysis.By establishing univariate and multivariate Logistic regression models,and comparing the area under the Receiver Operator Characteristic Curve(Area Under Curve,AUC)to evaluate the accuracy of each combined diagnosis model.Results1.Compared with the incomplete revascularization(IR)group,the incidence of MACCE in patients in complete revascularization(CR)group 6 months after PCI was lower(7.8%vs.24.0%.P<0.001),but There was no significant difference in cardiogenic mortality between the two groups(0.0%vs.0.6%,P=1.000).The 1-year incidence of MACCE in CR group was lower(22.0%vs.44.7%,P<0.001),but there was no significant difference in cardiogenic mortality between the two groups(0.0%vs.2.8%,P=0.122);2.CR is negatively correlated with 6-month MACCE(R=-0.215,P<0.001);CR is negatively correlated with 1-year MACCE(R=-0.237,P<0.001);3.Diabetes Mellitus combined with Chronic Total Occlusion(CTO)and GRACE score significantly improves the prediction accuracy of each variable alone for the 6-month MACCE of patients undergone PCI(AUC difference=0.052,P=0.018;AUC difference=0.156,P<0.001;AUC difference=0.118,P=0.004);Diabetes Mellitus combined with GRACE score can significantly improve the prediction accuracy of each variable alone for 1-year MACCE of patients undergone PCI;(AUC difference=0.072,P<0.001;AUC difference=0.211,P<0.001;AUC difference=0.126,P<0.001).4.HbA1c combined with CTO and GRACE score can significantly improve the accuracy of CTO and GRACE score in predicting the 6-month MACCE of patients undergone PCI(AUC difference=0.112,P=0.018;AUC difference=0.130,P=0.047);HbA1c combined CTO and GRACE score can significantly improve the accuracy of HbA1c,CTO and GRACE score in predicting 1-year MACCE in patients undergone PCI(AUC difference=0.110,P=0.047;AUC difference=0.129,P=0.003;AUC difference=0.128,P=0.019);5.Fasting blood glucose combined with CTO and GRACE score can significantly improve the prediction accuracy of CTO and GRACE score for 6-month MACCE of patients undergone PCI(AUC difference=0.082,P=0.035;AUC difference=0.054.P=0.026);Fasting blood glucose combined CTO situation and GRACE score can significantly improve the prediction accuracy of CTO and GRACE score for 1-year MACCE of patients undergone PCI(AUC difference=0.135,P<0.001;AUC difference=0.055,P=0.005);6.There is no statistical difference in the accuracy of these combined diagnostic model for 1-year MACCE diagnosis among all cases,CR group and IR group(0.766 vs.0.821 vs.0.724.P>0.05:0.789 vs.0.852 vs.0.760.P>0.05;0.694 vs.0.728 vs.0.646,P>0.05);Conclusion1.Diabetes Mellitus combined with CTO and GRACE score can significantly improve the accuracy of predicting MACCE in PCI patients at 6 months and 1 year;2.HbAlc combined with CTO and GRACE score can significantly improve the accuracy of CTO and GRACE score alone in predicting MACCE of PCI patients at 6 months and 1 year;3.Fasting blood glucose combined with CTO and GRACE score can significantly improve the accuracy of CTO and GRACE score alone in predicting MACCE of PCI patients at 6 months and 1 year;4.There is a certain but not statistically significant differences in the accuracy of these combined diagnostic model for 1-year MACCE diagnosis among all cases,CR group and IR group.5.Patients in the IR group are more likely to ensue MACCE events;6.Compared with IR group,CR can reduce the incidence of MACCE in patients with coronary heart disease 6 months and 1 year after PCI,but there is no significant difference in cardiogenic mortality between the two groups. |
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