The association between GRACE score at admission for myocardial infarction and the incidence of sudden cardiac arrests in long-term follow-up – the MADDEC study

Figures & data

Figure 1. Flow-chart of the inclusions and exclusion of the study population, as well as outcome variables of the study. Between 2017–2018 the GRACE score was only gathered from MI patients participating in the prospective MI-ECG study. There was no loss during the follow-up.

Table 1. Baseline characteristics of the study population.

Population	N = 1985
Mean age, years (SD)	68.5 (11.8)
Male, n (%)	1341 (67.6)
Mean systolic blood pressure*, mmHg (SD)	144 (29)
Mean heart rate*, beats per min (SD)	79.7 (21.7)
Estimated glomerular filtration rate*, ml/min/1.73 m^2 (IQR)	82.4 (66.0–93.0)
Median LVEF*, % (IQR)	50 (42 - 60)
Hypertension (%)	1238 (62.4)
Diabetes (%)	536 (27.0)
Peripheral artery disease, n (%)	177 (8.9)
Previously suffered myocardial infarction, n (%)	310 (15.6)
Previously suffered stroke or transient ischemic attack, n (%)	211 (10.6)
Previously known atrial fibrillation or flutter, n (%)	354 (17.8)
Killip class* (%)
1	1609 (81.1)
2	230 (11.6)
3	121 (6.1)
4	25 (1.3)
STEMI patients, n (%)	747 (37.6)
Mean GRACE* (SD)	118.7 (32.0)

Abbreviations: SD = Standard Deviation, IQR = Interquartile Range, STEMI = ST-Elevation Myocardial Infarction, GRACE = Global Registry of Acute Coronary Events, LVEF = Left Ventricular Ejection Fraction.

*At the point of admission.

Table 2. Associations between GRACE score and age independent GRACE score with SCA and SCD.

	SDH (95% CI)	p-value
SCA (N = 78)
Unadjusted	1.55 (1.29–1.85)	<0.001
LVEF adjusted	1.40 (1.13–1.72)	0.002
Age independent unadjusted*	1.41 (1.19–1.66)	<0.001
Age independent and LVEF adjusted*	1.25 (1.01–1.56)	0.046
SCA in patients without ICDs (N = 68)
Unadjusted	1.57 (1.30–1.90)	<0.001
LVEF adjusted	1.44 (1.16–1.81)	0.001
Age independent unadjusted*	1.42 (1.18–1.70)	<0.001
Age independent and LVEF adjusted*	1.28 (1.00–1.64)	0.048
SCD (N = 52)
Unadjusted	1.42 (1.12–1.79)	0.003
LVEF adjusted	1.28 (0.96–1.69)	0.092
Age independent unadjusted*	1.40 (1.15–1.67)	<0.001
Age independent and LVEF adjusted*	1.27 (0.98–1.64)	0.077
SCD in patients without ICDs (N = 42)
Unadjusted	1.40 (1.08–1.81)	0.012
LVEF adjusted	1.31 (0.96–1.80)	0.088
Age independent unadjusted*	1.38 (1.10–1.73)	0.006
Age independent and LVEF adjusted*	1.30 (0.96–1.77)	0.095

Abbreviations: SDH: Sub-distributional hazard; SCA: Sudden cardiac arrest; SCD: Sudden cardiac death; ICD: Implantable cardioverter-defibrillator; LVEF: Left ventricular ejection fraction; C.I.: Confidence Interval.

*GRACE score calculated by omitting patients’ age from the score.

Figure 2. The cumulative incidence of sudden cardiac arrests in patients stratified by baseline GRACE score. Sub-Distributional Hazard (SDH) for the middle and the highest tertile compared to the lowest one are presented in the figure.

Figure 3. The cumulative incidence of sudden cardiac arrests in patients stratified by age independent GRACE score. Sub-Distributional Hazard (SDH) for the middle and the highest tertile compared to the lowest one are presented in the figure.

Data availability statement

The anonymized data from this study are available upon request and for justified reasons.