The GRACE risk score predicted heart failure-related MACE (HR 1.02; 95% CI 1.01-1.03; p=0.001) but not ischemic MACE (HR 1.01; p=0.49) in contemporary post-MI patients undergoing cardiac rehabilitation.
Cohort (n=253)
No
Does the GRACE score predict ischemic and heart failure-related major adverse cardiovascular events in contemporary MI patients enrolled in a cardiac rehabilitation program?
In contemporary post-MI patients undergoing cardiac rehabilitation with good secondary prevention control, the GRACE score predicts heart failure events but not ischemic events.
Hazard Ratio: 1.02 (95% CI 1.01–1.03)
p-value: p=0.001
Abstract Background The Global Registry of Acute Coronary Events (GRACE) risk score was developed nearly two decades ago for early prognostic assessment in patients with acute coronary syndrome. However, control of cardiovascular risk factors and optimization of secondary prevention therapies during Cardiac Rehabilitation Programs (CRP) may limit the prognostic value of GRACE score in contemporary myocardial infarction (MI) patients. Purpose To analyse the prognostic value of GRACE score regarding ischemic and heart failure-related major adverse cardiovascular events (Isch-MACE and HF-MACE) in contemporary MI patients enrolled in a CRP. Methods MI sufferers between November 2021 and September 2024 submitted to our local CRP were included in a prospective registry. Baseline characteristics, including GRACE 2.0 risk score, were registered. We analysed secondary prevention goals before and after Phase 2 CRP, defined by smoking cessation, ambulatory blood pressure (BP) 130/80mmHg, low-density lipoprotein cholesterol (LDL-C) 55mg/dL, glycated haemoglobin (HbA1c) 7%, good adherence to Mediterranean diet (PREDIMED ≥8 points), and perfect therapeutic adherence (Morisky-Green = 4 points). Cardiovascular events during follow-up were registered, and two combined endpoints were defined - Isch-MACE (cardiovascular death, non-fatal MI, non-fatal stroke, or unplanned revascularization) and HF-MACE (cardiovascular death, readmission for HF, or decompensated HF requiring ambulatory uptitration of diuretic therapy). We evaluated the prognostic value of the GRACE score to predict Isch-MACE and HF-MACE using univariate Cox regression and area under the curve (AUC) of receiver-operating characteristic curves. Results 253 patients were included in the cohort (mean age 62.98±10.91 years, 81.8% male). In 195 (77.1%) patients who finished Phase 2 CRP, we observed smoking cessation in most previous smokers (85 out of 97, 87.6%), target ambulatory BP in 186 (95.4%) patients, LDL-C55mg/dL in 164 (84.1%) patients, HbA1c7% in 186 (95.4%) patients, good adherence to Mediterranean diet in 169 (86.7%) patients, and perfect therapeutic adherence in 177 (90.8%) patients. During a median follow-up of 1.34 1.01-1.69 years, we registered 12 Isch-MACE (4.7%, 3.54 per 100 patient-years) and 16 HF-MACE (6.3%, 4.72 per 100 patient-years). Non-fatal MI (n=7, 2.8%) and ambulatory HF decompensation (n=13, 5.1%) were the most frequent events. GRACE risk score (mean 119.55±30.04 points) didn't predict Isch-MACE (HR 1.01 0.99-1.03, p=0.49; AUC 0.52 0.35-0.68, p=0.86). However, a prognostic association was found with HF-MACE (HR 1.02 1.01-1.03, p=0.001, AUC 0.71 0.55-0.87, p=0.005). Conclusion In contemporary post-MI patients who achieve good control of secondary prevention goals during Phase 2 CRP, the rate of incident Isch-MACE is low and not predicted by GRACE score. However, this population show a higher risk of HF-MACE which can be predicted by GRACE score.Outcomes after Phase 2 CRP. GRACE score and Isch/HF-MACE.
Merenciano-Gonzalez et al. (Sat,) conducted a cohort in Myocardial infarction (n=253). GRACE risk score was evaluated on Isch-MACE (cardiovascular death, non-fatal MI, non-fatal stroke, or unplanned revascularization) and HF-MACE (cardiovascular death, readmission for HF, or decompensated HF) (HR 1.02, 95% CI 1.01-1.03, p=0.001). The GRACE risk score predicted heart failure-related MACE (HR 1.02; 95% CI 1.01-1.03; p=0.001) but not ischemic MACE (HR 1.01; p=0.49) in contemporary post-MI patients undergoing cardiac rehabilitation.