Admission Endothelial Activation and Stress Index in Acute Myocardial Infarction: Incremental Value Beyond the GRACE Score and a Test of the Index Weights

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.