Adjustment of the GRACE Risk Score by Monocyte to High-Density Lipoprotein Ratio Improves Prediction of Adverse Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Abstract

Background and AimsThe monocyte to high-density lipoprotein cholesterol ratio (MHR), a novel marker for inflammation and lipid metabolism, has been demonstrated to be associated with poor prognosis in many patient populations. However, the prognostic influence of MHR in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is poorly understood. Here, we sought to investigate the relationship between MHR and adverse cardiovascular (CV) outcomes in such patients and determine whether MHR could improve the GRACE risk score based prognostic models.Methods and ResultsMHR was applied to 1,720 patients with ACS undergoing PCI who were admitted to our CV center from June 2016 to November 2017. These patients were stratified into three groups according to MHR tertiles. The relationship between MHR and the primary endpoint (overall death, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization) was examined by Cox proportional hazards regression analysis. During a median follow-up of 31 months, 353 patients had at least one primary endpoint event. Compared with those in the lowest MHR tertile, patients in the middle and highest tertiles [adjusted HR: 1.541 (95% CI: 1.152–2.060) and 1.800 (95%CI: 1.333–2.432), respectively], had a higher risk of the primary endpoint. The addition of MHR has an incremental effect on the predictive ability of the GRACE risk score for the primary endpoint (cNRI: 0.136, P < 0.001; IDI: 0.006, P < 0.001).ConclusionMHR was independently and significantly associated with adverse CV outcomes in ACS patients who underwent PCI and improved the predictive ability of the GRACE risk score based prognostic models.Registration Numberhttp://www.chictr.org.cn/hvshowproject.aspx?id=21397; ChiCTR1800017417.

Combination of TyG Index and GRACE Risk Score as Long-Term Prognostic Marker in Patients with ACS Complicated with T2DM Undergoing PCI

“…Previous studies have shown that the predictive value of cardiovascular events is enhanced when the GRACE risk score is combined with other potential risk factors for ACS, such as the neutrophil to lymphocyte ratio or monocyte to high-density lipoprotein cholesterol ratio. 28 , 29 In the present study, we incorporated the TyG index into the GRACE risk score model to verify the predictive effect for MACEs in ACS patients with T2DM undergoing PCI. It has been revealed that the TyG index at baseline was significantly and positively associated with the GRACE risk score.…”

Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…Some potential risk factors beyond the GRACE risk score system have been identified, and these factors improve the predictive ability of adverse events after ACS. Considering the inflammatory biomarkers, hs-CRP and monocyte to HDL-C ratio could improve the predictive power of the GRACE risk score [ 14 , 54 ]. In this study, we showed that the novel biomarker SIRI could also improve the prognostic value of the GRACE risk score in patients with ACS undergoing PCI.…”