A Novel ABC Score Predicts Mortality in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Who underwent Percutaneous Coronary Intervention

Abstract

Objective In the present study, we aimed to establish a novel score to predict long-term mortality of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI). Methods A total of 2,174 NSTE-ACS patients from the CORFCHD-ZZ study were enrolled as the derivation cohort. The validation cohort including 1,808 NSTE-ACS patients were from the CORFCHD-PCI study. Receiver operating characteristic analysis and area under the curve (AUC) evaluation were used to select the candidate variables. The model performance was validated internally and externally. The primary outcome was cardiac mortality (CM). We also explored the model performance for all-cause mortality (ACM). Results Initially, 28 risk factors were selected and ranked according to their AUC values. Finally, we selected age, N-terminal pro-B-type natriuretic peptide, and creatinine to develop a novel prediction model named “ABC” model. The ABC model had a high discriminatory ability for both CM (C-index: 0.774, p < 0.001) and ACM (C-index: 0.758, p < 0.001) in the derivation cohort. In the validation cohort, the C-index of CM was 0.802 (p < 0.001) and that of ACM was 0.797 (p < 0.001), which suggested good discrimination. In addition, this model had adequate calibration in both the derivation and validation cohorts. Furthermore, the ABC score outperformed the GRACE score to predict mortality in NSTE-ACS patients who underwent PCI. Conclusion In the present study, we developed and validated a novel model to predict mortality in patients with NSTE-ACS who underwent PCI. This model can be used as a credible tool for risk assessment and management of NSTE-ACS after PCI.

Development and validation of a nomogram for predicting significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary artery syndrome with low-to-intermediate risk stratification

“…The potential mechanism of diabetes as a risk factor for cardiovascular disease may be due to the fact that hyperglycemia affects the coronary microvascular pathology, inflammation and sympathetic nervous system activity, vasospasm and circulatory structural remodeling, resulting in an increase in cardiovascular disease. HDL-C and NT-proBNP were valuable factors for SCAS prognosis, in line with previous findings (23)(24)(25). There is emerging evidence that high density-lipoprotein can reduce diabetes-related vascular complications through various pathways, low HDL-C is a residual and independent risk factor associated with coronary artery stenosis, myocardial infarction, increased risk of cardiovascular death who achieve optimal control of low-density lipoprotein cholesterol (26,27).…”

Prediction of major adverse cardiovascular events in patients with acute coronary syndrome: Development and validation of a non-invasive nomogram model based on autonomic nervous system assessment

“…Nevertheless, clinicians have not yet optimized implementation of the GRACE score in the risk stratification for death and myocardial infarction at 12-months, particularly in ACS patients who receive standardized treatment ( 22 , 23 ). Additionally, a retrospective cohort study of 3,982 ACS patients with non-ST-segment elevation found that incorporating available clinical variables, including age, N-terminal pro-brain type natriuretic peptide, and serum creatinine, into a novel ABC score provided better predictions of long-term mortality after PCI than the GRACE score ( 24 ). However, the GRACE score and ABC score do not rely on home monitoring of cardiovascular health, a simple, non-invasive, and ambulatory monitoring technique.…”

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

“…A possible explanation is that an elevated BNP level reflects a larger infarct size and progressive left ventricular remodelling, thus more obviously reflecting the degree of cardiac insufficiency [ 47 ]. Similar to BNP, LVEF also serves as a reference index for cardiac function to supply important prognostic information and should be included in approaches for stratifying risk after myocardial infarction [ 48 , 49 ] Many studies have reported that age is a significant risk factor for clinical events (cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization) after PCI [ 50 , 51 ]. The predictive ability of simple age cut-off points of 65 and 75 are similar to that of a more complex model with age as a continuous variable [ 16 ].…”