Observational studyCardiovascular diabetology2015
Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention.
Observational study in Cardiovascular diabetology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Prediction of Hospital Mortality in Patients with ST Segment Elevation Myocardial Infarction: Evolution of Risk Measurement Techniques and Assessment of Their Effectiveness (Review).Sovremennye tekhnologii v meditsine · 2024Pooled it
- Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials.Cardiovascular diabetology · 2016Pooled it
- The Combined Predictive Value of the GRACE Score and the ARC-HBR Criteria for Bleeding Risk After Percutaneous Coronary Intervention in STEMI Patients.International journal of general medicine · 2026Article
- Integrating the GRACE Score with the Ceramide Risk Score Enhances the Predictive Accuracy of Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.Reviews in cardiovascular medicine · 2025Article
- Performance of the Models Predicting In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction with Predictors in Categorical and Continuous Forms.Sovremennye tekhnologii v meditsine · 2024Article
- Adjustment of the GRACE score by the triglyceride glucose index improves the prediction of clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention.Cardiovascular diabetology · 2022Article
- Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients.Frontiers in cardiovascular medicine · 2022Article
- Nonlinear relationship between HbA1c and coronary artery calcium score progression: a secondary analysis based on a retrospective cohort study.Diabetology & metabolic syndrome · 2021Article
- Observational
- Predicting Long-Term Mortality in Patients with Angina across the Spectrum of Dysglycemia: A Machine Learning Approach.Diagnostics (Basel, Switzerland) · 2021Article
- Article
- Cost-effectiveness of increased influenza vaccination uptake against readmissions of major adverse cardiac events in the US.PloS one · 2019Article
- Prognostic Value of Neutrophil to Lymphocyte Ratio for In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction.Current medical science · 2018Article
- Article
- NTproBNP in insulin-resistance mediated conditions: overweight/obesity, metabolic syndrome and diabetes. The population-based Casale Monferrato Study.Cardiovascular diabetology · 2017Article
- Hemoglobin ACardiovascular diabetology · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI).
methodsWe enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman's rank correlation. Cumulative MACE curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
resultsDuring a median of 42.3 months (interquartile range 39.3-44.2 months), 16 (2.9%) were lost to follow-up, and patients experienced 69 (12.9%) MACEs: 51 (9.6%) all-cause deaths and 18 (3.4%) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95% CI 1.020-1.040; p < 0.001; 3.530; 95% CI 1.927-6.466; p < 0.001, respectively). Furthermore, Kaplan-Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001].
conclusionsHbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.