IMPLEMENTATION OF THE GRACE SCORE IN ACUTE CORONARY SYNDROME WITH RENAL DYSFUNCTION

Abstract

Aim. To investigate on the most significant predictors of cardiovascular risk in acute coronary (ACS) and kidney dysfunction (KD) patients, underwent percutaneous coronary intervention (PCI).Material and methods. Totally, 206 patients included into the study. As the criteria of KD glomerular filtration rate below 60 mL/min/1,73 m2 was taken, by CKD-EPI (2011) based on the blood creatinine concentration at hospitalization. In-hospital mortality was 13,1% (n=27). All-cause annual mortality was 15,5% (n=32), 3-year mortality — 21,8% (n=45).Results. Monofactorial analysis showed that the most significant factors of inhospital and long-term mortality in ACS and KD patients after PCI were congestive heart failure, stroke, myocardial infarction anamnesis, acute heart failure (AHF), hyperglycemia, prominent systolic dysfunction of myocardium, tachicardia and hypotension at admittance, multivessel disease, as acute kidney injury (AKI) developed during hospitalization (criteria RIFLE and AKIN). Step-by-step selection in Cox regression showed that the factors of in-hospital mortality were anamnesis of stroke, AHF at admittance, AKI development during hospitalization. C-statistics of the developed model was 0,82, that is seriously more significant than that of GRACE 2,0-0,74 score. In the analysis of long-term survival by Cox, it was revealed that stroke and myocardial infarction anamnesis, as AHF at admittance and AKI regardless of other factors, are related to the increase of fatal outcomes rate during one and three years of observation. Also, the area under ROC of the invented risk models was 0,84 and 0,76, respectively, for 1 and 3 years. In GRACE 2,0 such parameter was more significantly lower — 0,78 and 0,69, respectively.Conclusion. The results witness on the significance of additional risk factors introduction into risk assessment in patients with ACS and baseline KD, and the developed novel models were better than GRACE.

Keywords

• risk factors
• acute coronary syndrome
• renal dysfunction
• percutaneous coronary intervention