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Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction [Anatol J Cardiol]
Anatol J Cardiol. 2017; 18(3): 182-193 | DOI: 10.14744/AnatolJCardiol.2017.7798  

Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction

Yan Fan1, Jianjun Wang2, Sumei Zhang3, Zhaofei Wan4, Dong Zhou5, Yanhong Ding2, Qinli He1, Ping Xie1
1Department of Cardiovascular Medicine, Gansu Provincial Hospital; Lanzhou, Gansu-China
2The First People’s Hospital of Lanzhou; Lanzhou, Gansu-China
3Xi'an Medical University; Xi'an, Shaanxi-China
4Department of Cardiovascular Medicine, Affiliated Hospital of Yan’an University; Yan’an, Shaanxi-China
5Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine; Xi'an, Shaanxi-China

Objective: The present study aims to investigate whether the addition of homocysteine level to the Global Registry of Acute Coronary Events (GRACE) risk score enhances its predictive value for clinical outcomes in ST-elevation myocardial infarction (STEMI).
Methods: A total of 1143 consecutive patients with STEMI were included in this prospective cohort study. Homocysteine was detected, and the GRACE score was calculated. The predictive power of the GRACE score alone or combined with homocysteine was assessed by the receiver operating characteristic (ROC) analysis, methods of net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results: During a median follow-up period of 36.7 months, 271 (23.7%) patients reached the clinical endpoints. It showed that the GRACE score and homocysteine could independently predict all-cause death [GRACE: HR=1.031 (1.024–1.039), p<0.001; homocysteine: HR=1.023 (1.018–1.028), p<0.001] and MACE [GRACE: HR=1.008 (1.005–1.011), p<0.001; homocysteine: HR=1.022 (1.018–1.025), p<0.001]. When they were used in combination to assess the clinical outcomes, the area under the ROC curve significantly increased from 0.786 to 0.884 (95% CI=0.067–0.128, Z=6.307, p<0.001) for all-cause death and from 0.678 to 0.759 (95% CI=0.055–0.108, Z=5.943, p<0.001) for MACE. The addition of homocysteine to the GRACE model improved NRI (all-cause death: 0.575, p<0.001; MACE: 0.621, p=0.008) and IDI (all-cause death: 0.083, p<0.001; MACE: 0.130, p=0.016), indicating effective discrimination and reclassification.
Conclusion: Both the GRACE score and homocysteine are significant and independent predictors for clinical outcomes in patients with STEMI. A combination of them can develop a more predominant prediction for clinical outcomes in these patients.

Keywords: Global Registry of Acute Coronary Events risk score, homocysteine, ST-elevation myocardial infarction, all-cause death, major adverse cardiovascular events


Yan Fan, Jianjun Wang, Sumei Zhang, Zhaofei Wan, Dong Zhou, Yanhong Ding, Qinli He, Ping Xie. Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction. Anatol J Cardiol. 2017; 18(3): 182-193

Corresponding Author: Ping Xie, China


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