The Prognostic Value of the GRACE Score for Acute Kidney Injury in Patients with ST Elevation Myocardial Infarction Complicated with Cardiogenic Shock

Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has been proposed in predicting short-term death in patients who are diagnosed with acute coronary syndrome. The aim of the present study was to investigate the significance of the GRACE score for acute kidney injury (AKI) in patients with cardiogenic shock (CS)-ST elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PPCI). Materials and Methods: We retrospectively examined a total of 492 consecutive patients with CS-STEMI who had undergone PPCI. The GRACE score was calculated for each patient. Patients were stratified by tertiles (T1, T2, and T3) according to the GRACE score, and the incidence of AKI was compared between the groups. Results: In univariate analysis, the incidence of AKI was significantly higher for patients allocated into the T3 group than for patients in the T1 group (odds ratio (OR) 2.8, 95% confidence interval (CI) 1.8-4.1, p<0.001). Following including all confounding variables, participants in the T3 group had a 3.1-fold higher incidence of AKI (OR 3.1, 95% CI 1.9-5.4, p<0.001). In a receiver operating characteristic curve analysis, the GRACE score of the area under the curve value for AKI was 0.70 (95% CI 0.65-0.74, p<0.001) with 69.2% sensitivity and 68.8% specificity. Conclusion: The GRACE score provides an independent prognostic marker of AKI in patients with CS related with STEMI. Based on our data, we propose that the GRACE score is a simple and clinically applicable directive tool for rapid risk stratification of AKI in patients with STEMI complicated with CS.