Predictive value of three Inflammation-based Glasgow Prognostic Scores for major cardiovascular adverse events in patients with acute myocardial infarction during hospitalization: a retrospective study

Houyong Zhu; Zhaodong Li; Xiaoqun Xu; Xiaojiang Fang; Tielong Chen; Jinyu Huang

doi:10.7717/peerj.9068

Predictive value of three Inflammation-based Glasgow Prognostic Scores for major cardiovascular adverse events in patients with acute myocardial infarction during hospitalization: a retrospective study

PeerJ. 2020 Apr 24:8:e9068. doi: 10.7717/peerj.9068. eCollection 2020.

Authors

Houyong Zhu^#^{1

2}, Zhaodong Li^#³, Xiaoqun Xu³, Xiaojiang Fang², Tielong Chen², Jinyu Huang⁴

Affiliations

¹ Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine (Dingqiao District), Hangzhou, Zhejiang, China.
² Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine (Wulin District), Hangzhou, Zhejiang, China.
³ Department of Clinical Laboratory, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China.
⁴ Department of Cardiology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

^# Contributed equally.

Abstract

Aim: Inflammation-based Glasgow Prognostic Scores (GPS) have been reported to predict the prognosis of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The goal of this study was to investigate whether three kinds of GPSs can effectively predict major cardiovascular adverse events (MACEs) in STEMI or non-ST-segment elevation myocardial infarction (NSTEMI) patients undergoing PPCI, elective PCI (EPCI) or conservative drug therapy during hospitalization.

Methods: In this retrospective cohort study, patients with acute myocardial infarction (AMI) were divided into 0, 1 or 2 score according to the GPSs. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to assess the predictive value of GPSs for MACE and all-cause mortality during hospitalization. Three kinds of GPSs, Inflammation-based Glasgow Prognostic Score (GPS), modified GPS (MGPS) and high-sensitivity CRP-modified GPS (HS-MGPS) and Global Registry of Acute Coronary Events (GRACE) score were applied in this study.

Results: A total of 188 patients were enrolled. The ROC curve with MACE showed that the AUC of GPS (0.820 (95% confidence interval (CI) [0.754-0.885]), P < 0.001) was larger than that of MGPS (0.789 (95% CI [0.715-0.863]), P < 0.001), HS-MGPS (0.787 (95% CI [0.717-0.856]), P < 0.001) and GRACE score (0.743 (95% CI [0.672-0.814]), P < 0.001). The ROC curve with all-cause mortality showed that the AUC of GPS (0.696 (95% CI [0.561-0.831]), P = 0.005) was similar to the HS-MGPS (0.698 (95% CI [0.569-0.826]), P = 0.005) and higher than the MGPS (0.668 (95% CI [0.525-0.812]), P = 0.016), but lower than the GRACE score (0.812 (95% CI [0.734-0.889]), P < 0.001). Multivariate logistic regression analysis showed that the GPS was an independent risk factor for the incidence of MACE during hospitalization. Compared with the odds ratio (OR) value for a GPS of 0, the OR for a GPS of 1 was 7.173 (95% CI [2.425-21.216]), P < 0.001), and that for a GPS of 2 was 18.636 (95% CI [5.813-59.746]), P < 0.001), but not an independent risk factor for all-cause mortality (P = 0.302). GRACE score was an independent risk factor for MACE (1.019 (95% CI [1.004-1.035]), P = 0.015) and all-cause mortality (1.040 (95% CI [1.017-1.064]), P = 0.001). In the subgroups classified according to the type of AMI, the presence of disease interference GPSs and the type of PCI, the ability of GPS to predict the occurrence of MACE seemed to be greater than that of MGPS and HS-MGPS.

Conclusion: The GPS has a good predictive value for the occurrence of MACE during hospitalization in patients with AMI, regardless of STEMI or NSTEMI, the choice of PCI mode and the presence or absence of diseases that interfere with GPS. However, GPS is less predictive of all-cause mortality during hospitalization than GRACE score, which may be due to the interference of patients with other diseases.

Keywords: Acute myocardial infarction; Global Registry of Acute Coronary Events (GRACE) score; Inflammation-based Glasgow Prognostic Scores; Major cardiovascular adverse events; Non-ST-segment elevation myocardial infarction; ST-elevation myocardial infarction.

Grants and funding

This study was supported by the Science Technology Department of Zhejiang Province (2017C37130), and Hangzhou Health Science and Technology Project (2017Z10). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.