2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease

Cannon, Christopher P.; Brindis, Ralph G.; Chaitman, Bernard R.; Cohen, David J.; Cross, J. Thomas; Drozda, Joseph P.; Fesmire, Francis M.; Fintel, Dan J.; Fonarow, Gregg C.; Fox, Keith A.A.; Gray, Darryl T.; Harrington, Robert A.; Hicks, Karen A.; Hollander, Judd E.; Krumholz, Harlan; Labarthe, Darwin R.; Long, Janet B.; Mascette, Alice M.; Meyer, Connie; Peterson, Eric D.; Radford, Martha J.; Roe, Matthew T.; Richmann, James B.; Selker, Harry P.; Shahian, David M.; Shaw, Richard E.; Sprenger, Sharon; Swor, Robert A.; Underberg, James; Werf, Frans Van de; Weiner, Bonnie H.; Weintraub, William S.

doi:10.1161/cir.0b013e3182831a11

Cited by 152 publications

(82 citation statements)

References 45 publications

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“…Diagnosis of the different types of ACS and definitions of data variables were based on the American College of Cardiology (ACC) clinical data standards. 8 A Case Report Form (CRF) for each patient with suspected ACS was filled out upon hospital admission by assigned physicians and/or research assistants using standard definitions and was completed throughout the patient's hospital stay. All CRFs were verified by a cardiologist and then sent online to the principal coordinating center, where the forms were further checked for mistakes before submission for final analysis.…”

Section: Methodsmentioning

confidence: 99%

Age and clinical outcomes in patients presenting with acute coronary syndromes

Ahmed

AlHabib

El‐Menyar

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tContext: Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. Aims: To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). Methods and material: Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: 50 years, 51e70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. Statistical analysis used: One-way ANOVA test for continuous variables, Pearson chi-square (X 2 ) test for categorical variables and multivariate logistic regression analysis for predictors were performed. Results: Among 7930 consecutive ACS patients; 2755 (35%) were 50 years, 4110 (52%) were 51e70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients 50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03e1.60), heart failure (OR 2.8; 95% CI 2.17e3.52) and major bleeding (OR 4.02; 95% CI 1.37 e11.77) and in-hospital mortality (age 51e70: OR 2.67; 95% CI 1.86e3.85, and age >70: OR 4.71; 95% CI 3.11e7.14). Conclusion: Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.

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Section: Methodsmentioning

confidence: 99%

Age and clinical outcomes in patients presenting with acute coronary syndromes

Ahmed

AlHabib

El‐Menyar

et al. 2013

Journal of Cardiovascular Disease Research

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“…Our primary end points were the angiographic parameters which can demonstrate the myocardium reperfusion, including thrombolysis in myocardial infarction (TIMI) flow grade [11], TIMI frame count [12], and myocardial blush grade (MBG) [13]. All angiographic data were sent to a core lab in Shenyang Northern Hospital and analyzed by observers blinded to the allocated treatment.…”

Section: Endpoints and Follow-upmentioning

confidence: 99%

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

Han

Liu

Jing

et al. 2013

Cardiovascular Therapeutics

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SUMMARYObjectives: To elucidate the efficacy and safety of pharmacoinvasive therapy by using prourokinase (prouk) in patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients with STEMI often have long percutaneous coronary intervention (PCI)-related delays due to various reasons, which are associated with poor outcomes. Methods: A randomized study which enrolled patients from four centers in China was conducted. Patients were randomly assigned to accept routine primary PCI or prouk-PCI. The primary end points were the angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame count, and myocardial blush grade. Secondary endpoints were incidence of major adverse cardiac events (MACE, defined as death from all causes, reinfarction, revascularization, or rehospitalization due to new or worsening congestive heart failure) at 30 days and 1 year. Results: One hundred and ninety-seven eligible patients were enrolled, of whom 100 were randomized to the prouk-PCI group. Significantly more patients in the prouk-PCI group than in the PCI group had an opened infarct-related artery on arrival in the catheterization laboratory (48% vs. 21%, P = 0.0002) and better TIMI frame count after PCI (33 AE 6 vs. 40 AE 10, P < 0.001). At 1-year follow-up, there was a trend that patients in the prouk-PCI group had less chances to have MACE (7.0% vs. 12.6%, P = 0.235) or be readmitted to hospital due to new or worsening congestive heart failure (1.0% vs. 4.1%, P = 0.209). Conclusion: A strategy of emergent PCI preceded by fibrinolysis with prouk results in a better myocardial perfusion in infarct-related artery compared with primary PCI alone in patients with STEMI and long PCI-related delay.Primary percutaneous coronary intervention (PCI) is an effective treatment for ST-segment elevation myocardial infarction (STEMI) when it can be performed rapidly [1]. However, this procedure may not completely prevent further myocardial damage due to reperfusion injury and distal embolization [2]. More importantly, even in the hospital with primary PCI capability, patients with STEMI often have long PCI-related delays due to various reasons, which are associated with poorer outcomes [3]. In those patients, the appropriate and timely use of reperfusion therapy is likely more important than the choice of reperfusion methods. Indeed, American College of Cardiology/American Heart Association (ACC/AHA) guidelines recognize that one reperfusion approach is not superior for all patients, in all clinical settings, at all times of day [4]. The use of facilitated PCI was shown to be detrimental compared with primary PCI, with increased ischemic and bleeding events, and a trend toward excess mortality [5,6]. Conversely, among high-risk STEMI patients, the treatment with fibrinolysis and transferred for PCI within 6 h after fibrinolysis was associated with significantly fewer ischemic complications than that in standard treatment [7]. Tissue plasminogen activator (t-PA) is the commonly use...

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“…Patients were followed up at 90 days and at 1 year either by telephone or by a clinic visit. ACS included unstable angina, ST‐elevation myocardial infarction (STEMI) and non‐ST‐elevation MI, and all cardiovascular outcomes were measured as defined by the American College of Cardiology/American Heart Association task force on clinical data standards guidelines for ACS 9. All other clinical diagnoses, patient‐related variables, and outcomes used standardized definitions.…”

Section: Methodsmentioning

confidence: 99%

β‐Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In‐Hospital and 12‐Month Outcome: Results From the GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2)

Khalil

AlHabib

Singh

et al. 2017

JAHA

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BackgroundThe prognostic impact of β‐blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in‐hospital outcome in patients without HF, and whether they also reduce 12‐month mortality if still prescribed on discharge.Methods and ResultsThe GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in‐hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1‐year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in‐hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non‐BB group. Even after correcting for confounding factors in 2 different models, in‐hospital and 12‐month mortality risk was still lower in the BB group.ConclusionsIn this cohort of ACS, BB therapy before admission for ACS is associated with decreased in‐hospital mortality and major cardiovascular events, and 1‐year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge.

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2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease

Abstract: . Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

Cited by 152 publications

References 45 publications

Age and clinical outcomes in patients presenting with acute coronary syndromes

Age and clinical outcomes in patients presenting with acute coronary syndromes

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

β‐Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In‐Hospital and 12‐Month Outcome: Results From the GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2)

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