CORRELATION OF SERUM LOW-DENSITY LIPOPROTEIN CHOLESTEROL WITH GRACE AND TIMI SCORES TO PREDICT 30 DAYSMORTALITY FOLLOWING ACUTE CORONARY

Abstract

Objective: To assess the relationship of serum LDL-C and HDL-C levels with Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) Scores to predict all-cause 30 days mortality following first onset Acute Coronary Syndrome (ACS).

Study Design: Descriptive cross-sectional study. Place and Duration of Study: Inpatient departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan 2019 to Jun 2019.

Methodology: Ethical approval was taken from Institutional Ethical Review Board (IERB), AFIC/NIHD. Patients of any age and both genders who presented with chest pain and satisfied criteria for type 1 Myocardial Infarction (MI), as stated in 4th Universal Definition of MI, were included in study by non-probability consecutive sampling technique. Patients with a previous history of ischemic heart disease, Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG) surgery and patients taking lipids lowering medications over at least 3 months prior to admission were excluded. Both TIMI and GRACE scores for ST Elevation MI (STEMI) and Non-ST Elevation MI (NSTEMI) were calculated at time of admission. One non fasting blood sample was drawn for serum lipid levels from each patient within 24 hours of hospital admission and was analyzed using ROCHE cobas 6000 c501 analyzer. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 25.

Results: Out of 236 patients, 210 were male and 26 were female. Minimum recorded age was 25 years and maximum 90 years. Subjects presented with NSTEMI seem older (65.5 ± 7.3 years) than the ones presented with STEMI (59.7 ± 12.5 years). Anterior wall MI was the most common presentation (35%). Hypertension was the most common (57.6%) risk factor noted for Coronary Artery Disease (CAD). Serum lipids had a higher trend among STEMI subjects than NSTEMI and a lower trend among deceased subjects, as compared to survivors, in both STEMI and NSTEMI groups. Negative correlations were recorded between LDL-C and GRACE score in STEMI group (-0.277) and between HDL-C and both GRACE and TIMI scores (-0.349 and -0.299, respectively) in NSTEMI group.

Conclusion: A significant paradoxical lower levels of serum lipids were found in deceased subjects who presented with ACS.