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Dataset on blood biomarkers and GRACE score measured at admission for myocardial infarction in a large secondary hospital.

ABSTRACT: The GRACE score is currently the most widely used model to assess patient prognosis after myocardial infarction (MI). We have demonstrated that the prognostic performance of the GRACE score can be improved by adding blood biomarkers measured routinely at hospital admission in our study recently published in the International Journal of Cardiology: "Addition of routinely measured blood biomarkers significantly improves GRACE risk stratification in patients with myocardial infarction". In this Data-in-Brief article we present additional original data from our dataset. This dataset consists of clinical and biomarker information and follow-up data of 2055 confirmed MI patients. In 143 of these patients the endpoint (all-cause mortality or reMI) occurred during six months follow-up. We describe the differences in baseline characteristics between ST-elevation MI (STEMI) patients and non-STEMI patients, differences in biomarker levels at admission between patients in whom the endpoint occurred and patients who remained endpoint-free, and associations of the biomarkers with the endpoint. Moreover, we show additional statistical results of analyses that compare the original GRACE-only model with our extended GRACE/biomarker model.

SUBMITTER: van den Berg VJ

PROVIDER: S-EPMC6197650 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Dataset on blood biomarkers and GRACE score measured at admission for myocardial infarction in a large secondary hospital.

van den Berg Victor J VJ van Toorenburg Majorie M Drexhage Olivier O Boersma Eric E Kardys Isabella I Umans Victor A W M VAWM

Data in brief 20181003

The GRACE score is currently the most widely used model to assess patient prognosis after myocardial infarction (MI). We have demonstrated that the prognostic performance of the GRACE score can be improved by adding blood biomarkers measured routinely at hospital admission in our study recently published in the International Journal of Cardiology: "Addition of routinely measured blood biomarkers significantly improves GRACE risk stratification in patients with myocardial infarction". In this Dat ...[more]

PMID: 30364643

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Project description:BACKGROUND:Risk prediction after myocardial infarction is often complex in older patients. The Global Registry of Acute Coronary Events (GRACE) model includes clinical parameters and age, but not frailty. We hypothesised that frailty would enhance the prognostic properties of GRACE. METHODS:We performed a prospective observational cohort study in two independent cardiology units: the Royal Infirmary of Edinburgh, UK (primary cohort) and the South Yorkshire Cardiothoracic Centre, Sheffield, UK (external validation). The study sample included 198 patients ?65?years old hospitalised with type 1 myocardial infarction (primary cohort) and 96 patients ?65?years old undergoing cardiac catheterisation for myocardial infarction (external validation). Frailty was assessed using the Clinical Frailty Scale (CFS). The GRACE 2.0 estimated risk of 12-month mortality, Charlson comorbidity index and Karnofsky disability scale were also determined for each patient. RESULTS:Forty (20%) patients were frail (CFS ?5). These individuals had greater comorbidity, functional impairment and a higher risk of death at 12?months (49% vs. 9% in non-frail patients, p?<?0.001). The hazard of 12-month all-cause mortality nearly doubled per point increase in CFS after adjustment for age, sex and comorbidity (Hazard Ratio [HR] 1.90, 95% CI 1.47-2.44, p?<?0.001). The CFS had good discrimination for mortality by Receiver Operating Characteristic (ROC) curve analysis (Area Under the Curve [AUC] 0.81, 95% CI 0.72-0.89) and enhanced the GRACE estimate (AUC 0.86 vs. 0.80 without CFS, p?=?0.04). At existing GRACE thresholds, the CFS resulted in a Net Reclassification Improvement (NRI) of 0.44 (95% CI 0.28-0.60, p?<?0.001), largely through reductions in risk estimates amongst non-frail patients. Similar findings were observed in the external validation cohort (NRI 0.46, 95% CI 0.23-0.69, p?<?0.001). CONCLUSIONS:The GRACE score overestimated mortality risk after myocardial infarction in these cohorts of older patients. The CFS is a simple guided frailty tool that may enhance prediction in this setting. These findings merit evaluation in larger cohorts of unselected patients. TRIAL REGISTRATION:Clinicaltrials.gov; NCT02302014 (November 26th 2014, retrospectively registered).

Project description:Background Bleeding risk stratification in acute coronary syndrome is of highest clinical interest but current risk scores have limitations. We sought to develop and validate a new in-hospital bleeding risk score for patients with acute myocardial infarction. Methods and Results From the nationwide SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register, 97,597 patients with acute myocardial infarction enrolled from 2009 until 2014 were selected. A full model with 23 predictor variables and 8 interaction terms was fitted using logistic regression. The full model was approximated by a model with 5 predictors and 1 interaction term. Calibration, discrimination, and clinical utility was evaluated and compared with the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) and CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Ad verse Outcomes With Early Implementation of the ACC /AHA Guidelines) scores. Internal and temporal validity was assessed. In-hospital major bleeding, defined as fatal, intracranial, or requiring surgery or blood transfusion, occurred in 1356 patients (1.4%). The 5 predictors in the approximate model that constituted the SWEDEHEART score were hemoglobin, age, sex, creatinine, and C-reactive protein. The ACTION and CRUSADE scores were poorly calibrated in the derivation cohort and therefore were recalibrated. The SWEDEHEART score showed higher discriminative ability than both recalibrated scores, overall ( C-index 0.80 versus 0.73/0.72) and in all predefined subgroups. Decision curve analysis demonstrated consistently positive and higher net benefit for the SWEDEHEART score compared with both recalibrated scores across all clinically relevant decision thresholds. The original ACTION and CRUSADE scores showed negative net benefit. Conclusions The 5-item SWEDEHEART score discriminates in-hospital major bleeding in patients with acute myocardial infarction and has superior model performance compared with the recalibrated ACTION and CRUSADE scores.

Dataset Information

Dataset on blood biomarkers and GRACE score measured at admission for myocardial infarction in a large secondary hospital.

Publications

Dataset on blood biomarkers and GRACE score measured at admission for myocardial infarction in a large secondary hospital.

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