Clinical impact of estimated plasma volume status and its additive effect with the GRACE risk score on in-hospital and long-term mortality for acute myocardial infarction

Tsutomu Kawai, Daisaku Nakatani, Takahisa Yamada, Yasuhiko Sakata, Shungo Hikoso, Hiroya Mizuno, Shinichiro Suna, Tetsuhisa Kitamura, Katsuki Okada, Tomoharu Dohi, Takayuki Kojima, Bolrathanak Oeun, Akihiro Sunaga, Hirota Kida, Hiroshi Sato, Masatsugu Hori, Issei Komuro, Shunsuke Tamaki, Takashi Morita, Masatake FukunamiYasushi Sakata

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Estimated plasma volume status (ePVS) is a well-validated prognostic indicator in heart failure. However, it remains unclear whether ePVS has prognostic significance in patients with acute myocardial infarction (AMI). Moreover, there is no available information on its additive effect with the Global Registry of Acute Coronary Events (GRACE) risk score in AMI patients. Methods: Data were obtained from the Osaka Acute Coronary Insufficiency Study (OACIS) registry database. Patients whose data were available for ePVS derived from Hakim's formula and the GRACE risk score were studied. The primary endpoints were in-hospital and 5-year mortality. Results: Of 3930 patients, 206 and 200 patients died during hospitalization and 5 years after discharge, respectively. After adjustment, ePVS remained an independent predictor of in-hospital death (OR:1.02, 95% CI: 1.00–1.04, p = 0.036), and 5-year mortality(HR:1.03, 95% CI: 1.01–1.04, p < 0.001). An additive effect of ePVS with the GRACE risk score was observed in predicting the 5-year mortality with an area under the receiver operating characteristic curve (AUC) from 0.744 to 0.763 (p = 0.026), but not in-hospital mortality (the AUC changed from 0.875 to 0.875, p = 0.529). The incremental predictive value of combining ePVS and the GRACE risk score for 5-year mortality was significantly improved, as shown by the net reclassification improvement (NRI:0.378, p < 0.001) and integrated discrimination improvement (IDI:0.014, p < 0.001). Conclusions: In patients with AMI, ePVS independently predicted in-hospital and long-term mortality. In addition, ePVS had an additive effect with the GRACE risk score on long-term mortality. Therefore, ePVS may be useful for identifying high-risk subjects for intensive treatment.

Original languageEnglish
Article number100748
JournalIJC Heart and Vasculature
Volume33
DOIs
Publication statusPublished - 2021 Apr
Externally publishedYes

Keywords

  • Acute myocardial infarction
  • Plasma volume
  • Prognosis
  • The GRACE risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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