Prognostic significance of adropin with Grace and Gensini scores for in-hospital outcomes in ST: elevation myocardial infarction patients

Abstract

This prospective cohort study investigated the prognostic value of serum Adropin in patients with ST-segment elevation myocardial infarction (STEMI) and its incremental predictive utility beyond traditional GRACE and Gensini scores. A total of 508 participants were enrolled, including 308 STEMI patients, 100 chronic coronary syndrome (CCS) patients, and 100 individuals with normal coronary arteries. Serum Adropin levels were measured at admission, day 3, and day 5. Admission Adropin levels were significantly lower in STEMI patients compared to CCS and normal controls, and exhibited a dynamic increase during the acute phase. Admission Adropin levels were negatively correlated with GRACE score, Gensini score, number of diseased vessels, and in-hospital major adverse cardiovascular events (MACE). Multivariate logistic regression revealed that the level of Adropin at admission was closely associated with the occurrence of major adverse cardiovascular events (MACE) during hospitalization. When added to the GRACE score, Adropin significantly improved predictive performance, with enhanced net reclassification improvement (NRI = 0.34, 95% CI 0.18–0.50) and integrated discrimination improvement (IDI = 0.08, 95% CI 0.04–0.12). Additionally, low Adropin levels were associated with adverse clinical phenotypes, including higher Killip class, multi-vessel disease, elevated inflammatory markers, and metabolic disturbances. These findings suggest that Adropin could serve as a complementary biomarker for refined risk stratification in STEMI, particularly when combined with the GRACE score for early pre-procedural assessment.