Predictive value of GRACE score and vascular endothelial function at admission for mid- and longterm prognosis after operation of patients with acute coronary syndrome treated by percutaneous coronary intervention

Objective 　To investigate the predictive value of GRACE score at admission and vascular endothelial function for the mid- and long-term prognosis after operation of patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI). Methods 　Three hundred and thirty patients, undergoing percutaneous coronary intervention (PCI), were enrolled in Xinqiao Hospital of the Army Medical University from Dec. 2015 to Nov. 2017, and divided into low (n=158), medium (n=130) and high (n=42) risk groups according to GRACE score at admission, and further divided into endothelial dysfunction (DEF, n=198) group and normal endothelial function (NEF, n=132) group by reactive hyperemia index (RHI). During the follow-up (median follow-up time was 19 months) the major adverse cardiac events (MACEs) were recorded. Cox proportional hazard model was used to analyze the independent predictors of MACEs. Kaplan-Meier analysis and Log rank test were performed to compare the cumulative incidence of MACEs between groups. Results 　There were statistical significance in the incidences of MACEs and cardiac death among the low, medium and high risk groups (14.7% vs. 22.4% vs. 37.5%, P=0.005) and (0.6% vs. 2.3% vs. 10.0%, P=0.003). Kaplan-Meier analysis showed that there existed difference in the cumulative incidence of MACEs among these 3 groups (log-rank test: P=0.021), and the higher probability of MACEs was in DEF group than in NEF group (log-rank test: P<0.05). Multivariate Cox hazard analysis identified the GRACE risk stratification at admission (HR=1.48, 95%CI 1.07-2.06, P=0.018), RHI (HR=0.25, 95%CI 0.12-0.52, P=0.000) and numbers of diseased vessels (HR=1.51, 95%CI 1.10-2.07, P=0.010) were the independent predictors of future MACEs in ACS patients after PCI treatment. Conclusions 　Based on the GRACE risk stratification for ACS patients after PCI, RHI can further identify the higher risk patients effectively. RHI may improve the predictive value of GRACE score for mid-long-term prognosis of patients after PCI. DOI: 10.11855/j.issn.0577-7402.2018.12.07