Barthel Index as a Predictor of Mortality in Patients with Acute Coronary Syndrome: Better Activities of Daily Living, Better Prognosis

Figures & data

Figure 1 Flow chart of the enrollment of participants in the study.

Table 1 Relationships Between Baseline Clinical Characteristics and Barthel Index in Patients with Acute Coronary Syndrome

Variables	G1 (n = 1007)	G2 (n = 1120)	G3 (n = 781)	P-value
Demographics
Age, years	67.20 ± 13.40	64.95 ± 13.40	65.48 ± 12.17	<0.001
≥75 years, n (%)	337 (33.5%)	323 (28.8%)	178 (22.8%)	<0.001
Males, n (%)	741 (73.6%)	863 (77.1%)	588 (75.3%)	0.179
BMI, kg/m^2	23.88 ± 3.44	24.26 ± 3.35	24.97 ± 13.08	0.010
Medical histories
Smoking, n (%)	551 (54.7%)	657 (58.7%)	425 (54.4%)	0.097
Drinking, n (%)	315 (31.3%)	377 (33.8%)	258 (33.2%)	0.460
Hypertension, n (%)	550 (54.6%)	585 (52.2%)	435 (55.7%)	0.291
Diabetes, n (%)	287 (28.5%)	278 (24.8%)	210 (26.9%)	0.157
Hyperlipidemia, n (%)	106 (10.5%)	139 (12.4%)	99 (12.7%)	0.281
COPD, n (%)	30 (3.7%)	35 (4.1%)	22 (3.5%)	0.818
Admission SBP, mmHg	125.92 ± 25.12	128.76 ± 24.11	130.83 ± 23.07	<0.001
Admission DBP, mmHg	77.45 ± 16.33	78.54 ± 15.97	79.28 ± 15.20	0.048
Heart rate,/min	83.20 ± 20.60	80.82 ± 17.69	77.61 ± 15.16	<0.001
Killip class ≥ 2, n (%)	504 (50.0%)	453 (40.4%)	310 (39.7%)	<0.001
LVEF, (%)C	52.01 ± 11.95	53.77 ± 11.14	57.52 ± 12.05	<0.001
Laboratory findings
WBC, ×10^9/L	10.18 ± 3.89	9.91 ± 3.69	7.98 ±2.89	<0.001
Platelet count, ×10^9/L	182.38 ± 69.71	187.79 ± 75.56	185.1 ± 76.45	0.244
Fibrinogen, g/L	9.47 ± 4.49	9.29 ±4.13	9.04 ± 3.95	0.103
D-dimer, mg/L	1.72 (1.35–2.08)	0.99 (0.80–1.17)	0.70 (0.57–0.83)	<0.001
Blood glucose, mmol/L	9.23 ± 4.82	8.61 ± 3.70	8.31 ± 3.75	<0.001
Creatinine, μmol/L	105 (99–111)	93 (89–97)	92 (87–97)	0.001
BUN, mmol/L	7.42 ± 4.72	6.65 ± 3.99	6.33 ± 3.41	<0.001
Triglycerides, mmol/L	1.62 ± 1.44	1.73 ± 1.58	2.00 ± 1.66	<0.001
Total cholesterol, mmol/L	4.38 ± 1.26	4.49 ± 1.21	4.34 ± 1.27	0.022
HDL, mmol/L	1.15 ± 0.36	1.16 ± 0.33	1.12 ± 0.34	0.096
LDL, mmol/L	2.72 ± 1.10	2.80 ± 1.07	2.63 ± 1.09	0.002
NT-proBNP, pg/mL	3576 (3141–4010)	2447 (2167–2728)	1757 (1480–2035)	<0.001
CTnT, pg/mL	2474 (2271–2677)	2062 (1885–2240)	837 (714–960)	<0.001
Creatinine kinase, IU/L	1031(933–1129)	938(849–1026)	393 (339–447)	<0.001
CK-MB, U/L	73.2 (66.9–79.5)	65.1 (59.5–70.8)	24.7 (20.8–28.7)	<0.001
Culprit coronary vessel
Left main, n (%)	190 (18.9%)	190 (17.0%)	139 (17.8%)	0.519
LAD, n (%)	818 (81.2%)	947 (84.6%)	642 (82.2%)	0.065
Left circumflex, n (%)	656 (65.1%)	730 (65.2%)	494 (63.3%)	0.154
RCA, n (%)	735 (73.0%)	847 (75.6%)	570 (73.0%)	0.288
Risk score
GRACE score	155.22 ± 43.70	143.11 ± 37.84	137.04 ± 35.65	<0.001
Gensini score	79 (75–82)	72 (69–75)	59 (55–63)	<0.001
Type of ACS
STEMI	663 (33.1%)	724 (35.1%)	248 (31.8%)	<0.001
NSTEMI	225 (40.6%)	238 (44.2%)	216 (15.2%)	<0.001
UA	119 (20.0%)	158 (26.6%)	317 (53.4%)	<0.001

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; COPD, chronic obstructive pulmonary disease; WBC, white blood cell count; BUN, blood urea nitrogen; HDL, high-density lipoprotein; LDL, low-density lipoprotein; CTnT, cardiac troponin T; NT-proBNP, N-terminal pro-brain natriuretic peptide; CK-MB, creatinine kinase-myocardial band isoenzyme; CRP, C-reactive protein; LVEF, left ventricular ejection fraction; LAD, left anterior descending; RCA, right coronary artery; GRACE score, Global Registry of Acute Coronary Events score; ACS, acute coronary syndrome; STEMI, ST-segment elevated myocardial infarction; NSTEMI, non ST-segment elevated myocardial infarction; UA, unstable angina.

Figure 2 Scatter plot of GRACE score and BI (A); Gensini score and BI (B).

Abbreviations: BI, Barthel index; GRACE score, Global Registry of Acute Coronary Events score.

Table 2 In-Hospital and Long-Term Adverse Outcome of Patients Categorized by Barthel Index

Outcomes		G1 (n = 1007)	G2 (n = 1120)	G3 (n = 781)	P-value
In-hospital clinical outcomes, n (%)
	All-cause mortality, n (%)	70 (7.0%)	32 (2.9%)	7 (0.9%)	<0.001
	Cardiac death, n (%)	68 (6.8%)	28 (2.5%)	7 (0.9%)	<0.001
Clinical outcomes during follow-up, n (%)
	All-cause mortality, n (%)	141 (14.4%)	101 (9.2%)	35 (4.7%)	<0.001
	Cardiac death, n (%)	115 (11.5%)	81 (7.3%)	32 (4.1%)	<0.001

Figure 3 Kaplan–Meier survival curve of all-cause death for NST-ACS patients (A), cardiac death for NST-ACS patients (B), all-cause death for STEMI patients (C) and cardiac death for STEMI patients (D) by Barthel index score.

Abbreviations: G1, group 1; G2, group 2; G3, group 3.

Figure 4 ROC curves for GRACE score, Gensini score and BI in relation to all-cause mortality (A) and cardiac mortality (B).

Abbreviations: BI, Barthel index; GRACE score, Global Registry of Acute Coronary Events score; ROC, receiver operating characteristic.

Table 3 Cox Regression Analysis Regarding Correlations Between All-Cause Mortality and Barthel Index

Variable	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P-value	HR	95% CI	P-value
BI			<0.001			0.004
G1 vs G3	3.392	2.342–4.912	<0.001	2.147	1.372–3.359	0.001
G2 vs G3	2.109	1.436–3.099	<0.001	1.747	1.105–2.761	0.017
Age	1.050	1.040–1.061	<0.001	1.017	1.002–1.033	0.023
Sex	1.641	1.281–2.101	<0.001	1.066	0.721–1.575	0.749
Smoking	1.287	1.098–1.437	0.005	1.194	0.819–1.739	0.357
Drinking	1.352	1.148–1.507	0.002	0.881	0.614–1.265	0.493
Hypertension	1.108	0.875–1.405	0.045	1.145	0.848–1.546	0.378
Diabetes	1.404	1.094–1.803	0.008	1.305	0.959–1.776	0.091
Gensini score	1.006	1.004–1.008	<0.001	1.004	1.001–1.006	0.002
GRACE score			<0.001			<0.001
Medium^a vs low^b risk	2.707	1.121–6.538	0.027	1.850	0.748–4.576	0.183
High^c vs low risk	14.439	6.419–32.482	<0.001	6.191	2.611–14.679	<0.001

Notes: ^aMedium risk: 108–140; ^bLow risk: ≤108; ^cHigh risk: >140.

Abbreviations: BI, Barthel index; GRACE score, Global Registry of Acute Coronary Events score; HR, hazard ratio; CI, confidence interval.

Table 4 Kaplan–Meier Survival Analysis of Mortality in Acute Coronary Syndrome Patients

Subgroups	Cumulative Survival Rate			Log Rank χ^2	P-value
	G1	G2	G3
Gender
Male (n = 2192)	0.787	0.850	0.938	33.237	<0.001
Female (n = 716)	0.645	0.726	0.851	14.665	0.001
Age^a
≤65 (n = 1396)	0.820	0.887	0.961	13.162	0.001
>65 (n = 1512)	0.601	0.764	0.830	25.670	<0.001
BMI^b, kg/m^2
≤24 (n = 1501)	0.625	0.708	0.856	21.713	<0.001
>24 (n = 1407)	0.829	0.909	0.955	24.125	<0.001
SBP^b, mmHg
≤127 (n = 1480)	0.690	0.821	0.869	32.309	<0.001
>127 (n = 1428)	0.791	0.824	0.964	20.087	<0.001
DBP^b, mmHg
≤77 (n = 1468)	0.722	0.797	0.877	24.376	<0.001
>77 (n = 1440)	0.750	0.849	0.957	25.177	<0.001
Heart rate^b/min
≤78 (n = 1430)	0.759	0.889	0.919	14.196	0.001
>78 (n = 1478)	0.706	0.766	0.910	28.688	<0.001
WBC^b, 10^9/L
≤9 (n = 1412)	0.747	0.830	0.943	22.445	<0.001
>9 (n = 1496)	0.731	0.816	0.848	15.209	<0.001
Platelet count^b,10^9/L
≤180 (n = 1415)	0.695	0.810	0.898	32.474	<0.001
>180 (n = 1493)	0.790	0.836	0.938	15.776	<0.001
Hemoglobin^b, g/L
≤137 (n = 1448)	0.682	0.779	0.864	24.597	<0.001
>137 (n = 1460)	0.814	0.871	0.967	16.112	<0.001
Troponin T^b, pg/mL
≤247 (n = 1472)	0.753	0.805	0.949	0.969	<0.001
>247 (n = 1436)	0.744	0.841	0.860	0.982	<0.001
NT-proBNP^b, pg/mL
≤813 (n = 1429)	0.876	0.885	0.973	7.866	0.020
>813 (n = 1479)	0.619	0.741	0.803	24.622	<0.001
Killip class^c
I (n = 1267)	0.943	0.920	0.955	4.557	0.102
II–IV (n = 1641)	0.522	0.662	0.856	36.032	<0.001
GRACE score^b
≤142 (n = 1421)	0.921	0.943	0.979	3.994	0.136
>142 (n = 1487)	0.600	0.682	0.810	25.727	<0.001
ACS type
STEMI (n = 1635)	0.727	0.760	0.938	36.614	<0.001
NST-ACS (n = 1273)	0.741	0.850	0.874	15.721	<0.001
Polypharmacy (≥5 drugs)
Yes (n = 1318)	0.762	0.812	0.923	14.018	0.001
No (n = 1590)	0.716	0.837	0.903	36.596	<0.001

Notes: ^aThe cutoff point for age was according to the definition of the elderly (65 years old); ^bThe cutoff points for these variates were medians; ^cThe cutoff point for Killip class was having congestive heart failure (≥II).

Abbreviations: HR, hazard ratio; CI, confidence interval; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; WBC, white blood cell; GRACE score, Global Registry of Acute Coronary Events score. ACS, acute coronary syndrome; STEMI, ST-elevation myocardial infarction; NST-ACS, non-ST elevation acute coronary syndrome