Predictors of major adverse cardiovascular events within six- months post-ST elevation myocardial infarction using GRACE risk score


  • Kamonnard Mookmontien Graduate Nursing Student, Master of Nursing Science Program in Adult Nursing, Walailak University School of Nursing
  • Anuwat Rintaravitoon Department of Cardiology, Maharatnakhonsithammarat Hospital
  • Rewwadee Petsirasan School of Nursing, Walailak University
  • Chennet Phonphet School of Nursing, Walailak University
  • Jom Suwanno School of Nursing, Walailak University


GRACE risk score, ST elevation myocardial infarction, major adverse cardiovascular events


        This analytical, prospective study aimed to determine risk level and predictors for major adverse cardiovascular events using the Otago-Southland Global Registry of Acute Coronary Events (GRACE) risk score. Eligible 181 STEMI patients who admitted at a 600-bed tertiary hospital from October, 2017 to March, 2018 were recruited. Logistic regression was used to determine the predictors of major adverse cardiovascular events.

        Results:The higher GRACE scores were associated significantly with major adverse cardiovascular events (Chi-square 14.04, p = 0.001). An approximate 13-fold increment in mortality risk was found in STEMI patients with moderate scores risk (OR 13.6, 95%Cl 1.75-106.48) and a 22 fold increase in those with severe scores (OR 22.5, 95%Cl 2.75-185.4). The final multivariate model showed that nine risk factors could significantly explained for 86.2% (p = 0.001) of mortality risk. An increment in mortality risk was found in STEMI patients with aged > 60 years, previous myocardial ischemia, heart rate at ER of > 90 beat per minute, systolic blood pressure at ER of < 160 mmHg, serum creatinine of > 0.8 mg/dl, a history of heart failure, elevated cardiac enzymes, and post percutaneous coronary intervention.

        Using the GRACE risk score can be prognostic a major adverse cardiovascular event for the first
six-month after discharge. Patients with STEMI who had moderate-to-severe GRACE risk scores require further developed specific health care and follow-up system in order to prevent the major adverse cardiovascular events.


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