Admission Endothelial Activation and Stress Index in Acute Myocardial Infarction: Incremental Value Beyond the GRACE Score and a Test of the Index Weights
- 1Department of Cardiology, University of Health Sciences, Kocaeli City Hospital, 41060 İzmit, Türkiye
- 2Independent Researcher, 06000 Ankara, Türkiye
Abstract
Background/Objectives: The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine and platelet count, has been linked to mortality in cardiovascular cohorts. We examined whether admission EASIX adds prognostic information to the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in acute myocardial infarction (AMI), and whether its fixed weights are supported. Methods: We retrospectively studied consecutive adults with AMI undergoing coronary angiography; patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2 were excluded. EASIX was modelled on the log2 scale. Incremental value was assessed against a GRACE model refitted in this cohort and against the published GRACE risk after recalibration, by discrimination, calibration, decision curves and bootstrap validation. Results: In-hospital death occurred in 225 of 4777 patients (4.7%). Each doubling of EASIX was associated with mortality after adjustment for the GRACE score (odds ratio 2.386, 95% confidence interval 2.053–2.774) and after clinical adjustment (2.363, 1.974–2.828). Adding EASIX raised the area under the curve from 0.855 to 0.890 (optimism-corrected increment 0.034, 95% confidence interval 0.025–0.052) and improved the Brier score and net benefit. Added to the recalibrated published GRACE risk, EASIX raised the area under the curve from 0.856 to 0.881 (corrected increment 0.024, 0.012–0.040). Findings were consistent in both infarct types. Freely estimated weights differed from the fixed weights but added little discrimination. Conclusions: Admission EASIX was independently associated with in-hospital mortality in AMI and added discrimination and net benefit to both a refitted and the published GRACE risk. External validation is required before clinical use.
Related
- The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department.
- Association Between Admission Calculated Serum Osmolality and New-Onset Atrial Fibrillation in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
- Circulating CARMN for acute myocardial infarction prognosis and its incremental effect when combined with conventional biomarkers
- Admission cardiac and renal biomarkers for early identification of type 1 cardiorenal syndrome after acute myocardial infarction
- Association Between Admission Estimated Glomerular Filtration Rate and Long-Term Mortality in Patients with Acute Myocardial Infarction
BibTeX
@article{sahin2026admission,
title = {{Admission Endothelial Activation and Stress Index in Acute Myocardial Infarction: Incremental Value Beyond the GRACE Score and a Test of the Index Weights}},
author = {Kader Eliz Şahin and Ahmet Berk Duman and Şadiye Nur Dalgıç and Denizhan Karaçimen and Yalçın Dalgıç and Metin Çağdaş and Sedat Avcı and Ayşe Hoşoğlu},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197703},
url = {https://europepmc.org/article/PMC/PMC13666320},
note = {CC BY},
}
RIS
TY - JOUR
TI - Admission Endothelial Activation and Stress Index in Acute Myocardial Infarction: Incremental Value Beyond the GRACE Score and a Test of the Index Weights
AU - Kader Eliz Şahin
AU - Ahmet Berk Duman
AU - Şadiye Nur Dalgıç
AU - Denizhan Karaçimen
AU - Yalçın Dalgıç
AU - Metin Çağdaş
AU - Sedat Avcı
AU - Ayşe Hoşoğlu
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197703
UR - https://europepmc.org/article/PMC/PMC13666320
AB - Background/Objectives: The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine and platelet count, has been linked to mortality in cardiovascular cohorts. We examined whether admission EASIX adds prognostic information to the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in acute myocardial infarction (AMI), and whether its fixed weights are supported. Methods: We retrospectively studied consecutive adults with AMI undergoing coronary angiography; patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2 were excluded. EASIX was modelled on the log2 scale. Incremental value was assessed against a GRACE model refitted in this cohort and against the published GRACE risk after recalibration, by discrimination, calibration, decision curves and bootstrap validation. Results: In-hospital death occurred in 225 of 4777 patients (4.7%). Each doubling of EASIX was associated with mortality after adjustment for the GRACE score (odds ratio 2.386, 95% confidence interval 2.053–2.774) and after clinical adjustment (2.363, 1.974–2.828). Adding EASIX raised the area under the curve from 0.855 to 0.890 (optimism-corrected increment 0.034, 95% confidence interval 0.025–0.052) and improved the Brier score and net benefit. Added to the recalibrated published GRACE risk, EASIX raised the area under the curve from 0.856 to 0.881 (corrected increment 0.024, 0.012–0.040). Findings were consistent in both infarct types. Freely estimated weights differed from the fixed weights but added little discrimination. Conclusions: Admission EASIX was independently associated with in-hospital mortality in AMI and added discrimination and net benefit to both a refitted and the published GRACE risk. External validation is required before clinical use.
SN - 2077-0383
ER -