COMPARATION BETWEEN DOOR TO WIRE TIME AND GRACE SCORE TO PREDICT MAJOR ADVERSE CARDIOVASCULAR EVENT IN ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Abstract

ABSTRACT

COMPARATION BETWEEN DOOR TO WIRE TIME AND GRACE SCORE TO PREDICT MAJOR ADVERSE CARDIOVASCULAR EVENT                                                    IN ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

(Saragih Erlinda, Rampengan H Starry, Jim L Edmond)

 Background: Primary percutaneous coronary intervention (PPCI) is the mainstay of treatment for ST segment elevation acute myocardial infarction (STEMI) patients. Delays in terms of Door to Wire will affect the outcome of STEMI, one of which is MACE. Risk stratification screening with Global Registry of Acute Coronary Event (GRACE) scores is important to assess Major Cardiovascular Events (MACE) in STEMI  patients. The purpose of this study was to assess the correlation of Door to Wire time and GRACE score with  MACE in STEMI patients, especially in Manado, North Sulawesi.

Methods: This study is an observational study, using a cohort design, data were collected from medical records for analysis.

Results: A total of 218 STEMI patients who underwent PPCI contributed to this study. Correlation analysis using all cases did not show a correlation between Door to Wire time and GRACE scores, but in a subpopulation analysis with Door to Wire time of up to 600 minutes (10 hours) found a weak but significant positive correlation (r = 0.26; p < 0.001 ), which changed to a moderately positive relationship in the subgroup without MACE (r = 0.56; p < 0.001).   A stronger correlation was seen in the analysis involving only samples with GRACE scores ≤ 154 and still limiting the Door to Wire time to 600 minutes. The Correlation disappeared again after the analysis was further reduced to cases with a GRACE score 125  even though a significant correlation was still seen in the subgroup without MACE (r = 0.43; p = 0.034). The optimal cut-off point for the GRACE score was obtained at a value of 127, where the sensitivity, specificity and accuracy of MACE predictions are around 86%, 75%, and 84%, respectively. For Door to Wire time, the optimal point is around 179.5 minutes where the sensitivity, specificity and accuracy of MACE predictions are around 69%, 56%, and 67%, respectively.

Conclusion: The GRACE score is superior to Door to Wire for predicting MACE in STEMI patients.

Keywords: Door to Wire time, GRACE score, MACE, STEMI