title: Neutrophil count improves the GRACE risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Both the Global Registry of Acute Coronary Events (GRACE) risk score and neutrophil count could predict clinical outcomes in patients with acute coronary syndromes. However, the ability of them to identify high risk patients leaves room for improvement. The purpose of the present study was to evaluate whether the combination of them could have a better performance in predicting clinical outcomes in patients with ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  A total of 1287 consecutive STEMI patients were recruited at two centers in China. Neutrophil count was measured and the GRACE risk score was calculated.
  
  
  RESULTS
  During a median period of 37 months (IQR, 29-47), 135 (10.9%) patients had major adverse cardiovascular events (MACE), including 116 all-cause death. Neutrophil count and the GRACE risk score were higher in patients with MACE. Both neutrophil count and the GRACE score were significant and independent predictors for MACE [HR: 1.260 (1.203-1.319), P < 0.001; HR: 1.007 (1.002-1.011), P < 0.001; respectively). Combination of them increased the area under the ROC (0.698 vs. 0.796, P < 0.001). The addition of neutrophil count to GRACE model enhanced net reclassification improvement (0.637, P = 0.020) and integrated discrimination improvement (0.180, P < 0.001), suggesting effective discrimination and reclassification.
  
  
  CONCLUSIONS
  Both neutrophil count and the GRACE risk score are independent predictors for MACE in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcomes in these patients.
authors.affiliation: Xi'an Medical University, Xi'an, Shaanxi 710021, China.
authors.forename: Sumei
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
authors.forename: Zhaofei
authors.initials: Z
authors.lastname: Wan
authors.affiliation: Xi'an Medical University, Xi'an, Shaanxi 710021, China.
authors.forename: Yongai
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Gansu Provincial People's Hospital, Lanzhou, 730000, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Nursing, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Gu
authors.affiliation: Xi'an Medical University, Xi'an, Shaanxi 710021, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.affiliation: Xi'an Medical University, Xi'an, Shaanxi 710021, China.
authors.forename: Li
authors.initials: L
authors.lastname: Meng
authors.affiliation: The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zeng
authors.affiliation: The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China.
authors.forename: Dongfang
authors.initials: D
authors.lastname: Han
authors.affiliation: Department of Nursing, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China. Electronic address: roselee@mail.xjtu.edu.cn.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Li
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology; D000368:Aged; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D009504:Neutrophils / Q000166:cytology*; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Neutrophil count; ST-elevation myocardial infarction; The GRACE risk score