Adjustment of the GRACE score by the stress hyperglycemia ratio improves the prediction of long-term major adverse cardiac events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A multicenter retrospective study
Authors' conclusion
The SHR is an independent predictor of long-term MACEs in ACS patients undergoing PCI and markedly improves the performance of the GRACE score.
Study context
- Population
- Acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), 11 hospitals
- Exposure
- GRACE score adjusted by stress hyperglycemia ratio (SHR) vs GRACE score alone
- Outcome
- Long-term MACEs: composite of all-cause mortality and nonfatal MI
- Follow-up
- Median 31.33 months
Methodological detailsdevelopment-validation
- Development-validation
Main finding
As reported in the abstract
Prediction of long-term MACEs (derivation cohort)
Continuous net reclassification improvement
30.5%
GRACE + SHR
Integrated discrimination improvement
0.042
P < 0.01
GRACE + SHR
GRACE + SHR
0.727
95% CI 0.616–0.837
C-statistic
GRACE
0.706
95% CI 0.599–0.813
C-statistic
- SHR independently predicted long-term major adverse cardiac events (MACEs) (HR)
- 3.3479; 95% CI 1.4103-7.9475; P = 0.0062
Observational data: associations, not effects.
Further findings
Validation cohort performance
- Addition of SHR showed superior discrimination and good calibration in the validation cohort
Original publication
Adjustment of the GRACE score by the stress hyperglycemia ratio improves the prediction of long-term major adverse cardiac events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A multicenter retrospective study. Diabetes Res Clin Pract. Published 5 March 2023. doi:10.
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