Vol 71, No 7 (2013)
Original articles
Published online: 2013-07-17
Adding lipoprotein(a) levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome
DOI: 10.5603/KP.2013.0156
Kardiol Pol 2013;71(7):695-701.
Abstract
Background: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with premature
coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between
Lp(a) and risk scoring systems remains unclear.
Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS.
Methods: 115 patients (mean age 64 ± 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled
in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables
in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI)
history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular
outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up.
Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events
(OR: 2.969 [95% CI 1.413–6.240] and OR: 6.279 [95% Cl 1.363–28.927] respectively). Lp(a) quartile also remained as an
independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402–4.780]).
Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001).
Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in
NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS.
coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between
Lp(a) and risk scoring systems remains unclear.
Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS.
Methods: 115 patients (mean age 64 ± 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled
in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables
in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI)
history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular
outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up.
Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events
(OR: 2.969 [95% CI 1.413–6.240] and OR: 6.279 [95% Cl 1.363–28.927] respectively). Lp(a) quartile also remained as an
independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402–4.780]).
Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001).
Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in
NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS.
Keywords: lipoprotein(a)acute coronary syndromesGRACE risk score
