Grace Risk Score 2.0 predicts acute coronary syndrome outcomes: what marker of myocardial injury should we use?

Aim. To compare the effectiveness of various markers of myocardial injury (creatine phosphokinase MB-fraction (CK-MB), cardiac troponin I, measured by standard and high sensitivity methods (cTnI and hs-TnI), and heart-type fatty acids binding protein (H-FABP)) in predicting the ACS course using the GRACE 2.0 score.

Methods. 183 patients with a verified diagnosis of ACS were included in the study. The levels of CK-MB, cTnl, hs-Tnl and H-FABP were measured at admission. Qualitative assessment of H-FABP was performed by immunochromatographic express-tests “CARD-INFO” and “CardioFABP”. Risk assessment of death in the in-hospital period and within the 12-months follow-up period, as well as death and/or acute myocardial infarction (AMI) within the 12-months follow-up was estimated using the GRACE 2.0 score with alternate inclusion of the various cardiomarkers. The effectiveness of the resultant prognostic scales was evaluated using the ROC-analysis and comparison of the areas under the curve (AUC).

Results. 114 patients (62.3%) were diagnosed with AMI and 69 (37.7%) with unstable angina. 10 patients (5.5%) died during the indexed hospitalization. Four patients died within the follow-up and 8 patients (4.4%) had Ami. 94 patients (51.3%) had elevated hs-Tnl levels at admission, 90 patients (49.2%) - cTnl, 45 patients (24.6%) - CK-MB. H-FABP levels were elevated in 70 (38.3%). The express-test “CARD-INFO” was positive in 86 patients (47.0%), the “CardioFABP” - in 125 (68.3%). There were no significant differences found between the stratification of ACS patients by the GRACE 2.0 score into high and non-high risk groups in terms of complications (p<0.05). Similarly, there were no significant differences found between the AUC values of the cardiomarkers in terms of developing the endpoints using the GRACE 2.0 score (p<0.05).

Conclusion. The introduction of H-FABP in the GRACE 2.0 scale is non-inferior to traditional markers of myocardial damage and may be used to stratify risk in patients with ACS.

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