Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)**Further information about the project, along with a complete list of the study participants, can be found at www.outcomes.org/grace.

Steg, Philippe Gabriel; Goldberg, Robert J.; Gore, Joel M.; Fox, Keith A.A.; Eagle, Kim A.; Flather, Marcus; Sadiq, Immad; Kasper, Rachel; Rushton-Mellor, Sophie K; Anderson, Frederick A.

doi:10.1016/s0002-9149(02)02489-x

Cited by 518 publications

(132 citation statements)

References 17 publications

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“…McClelland et al [41] reported improved survival in thrombolytic patients who underwent in-hospital coronary revascularization. These data support the current practice of frequent referral of STEMI patients for revascularization [42, 43] as amplified in current PCI guidelines [44]. …”

Section: Discussionsupporting

confidence: 76%

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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Background: Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue/definitive revascularization strategy could achieve salutary short- and long-term outcomes. Methods: A prospective registry documented all 212 STEMI patients who received initial thrombolytic therapy over a 2-year period in a single medical center. Median patient age was 58 (range: 29–92) years, 47 (22%) patients were aged >70 years and 18 (8%) >80 years. Fifty-two (25%) patients underwent rescue angioplasty <6 h after thrombolysis for inadequate clinical reperfusion. In 194/212 (92%) patients, coronary angiography was performed during initial hospitalization, PCI in 168 (79%), and coronary bypass surgery in 18 (8%). Results: Thirty-day mortality was 4.7% and 1-year mortality 6.7%. Mortality was not related to diabetes mellitus, hypertension, anterior infarction location, fibrin-specific thrombolytic drug or rescue PCI. By multivariate analysis, in-hospital definitive angiography/revascularization (p < 0.0001) and TIMI risk score >3 on admission (p < 0.01) were significant independent predictors of both 30 day and 12 month outcome. Conclusions: Initial thrombolysis was useful and effective in real-world STEMI patients when coupled with an aggressive policy of rescue angioplasty and early in-hospital revascularization. Outcomes compared favorably with those reported for PPCI trials. The adverse prognosis in older patients with higher TIMI risk score suggests that in those patients alternative initial treatment strategies such as PPCI should be considered.

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Section: Discussionsupporting

confidence: 76%

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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“…In a sensitivity analysis, we estimated the additional YLD that may be attributable to ≈41% of acute coronary events that are unstable angina observed in the Global Registry of Acute Coronary Events, a 14-nation registry of acute coronary syndrome cases in 95 hospitals in North America, South America, Europe, Australia, and New Zealand. 2 Accordingly, we reported the effect on YLD and DALYs of adding an additional 69% to the AMI YLD estimate, assuming that unstable angina has the same symptom severity as AMI.…”

Section: Methodsmentioning

confidence: 99%

The Global Burden of Ischemic Heart Disease in 1990 and 2010

et al. 2014

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Background Ischemic heart disease (IHD) burden consists of years of life lost from IHD deaths and years of disability lived with 3 nonfatal IHD sequelae: nonfatal acute myocardial infarction, angina pectoris, and ischemic heart failure. Our aim was to estimate the global and regional burden of IHD in 1990 and 2010. Methods and Results Global and regional estimates of acute myocardial infarction incidence and angina and heart failure prevalence by age, sex, and world region in 1990 and 2010 were estimated based on data from a systematic review and nonlinear mixed-effects meta-regression methods. Age-standardized acute myocardial infarction incidence and angina prevalence decreased globally between 1990 and 2010; ischemic heart failure prevalence increased slightly. The global burden of IHD increased by 29 million disability-adjusted life-years (29% increase) between 1990 and 2010. About 32.4% of the growth in global IHD disability-adjusted life-years between 1990 and 2010 was attributable to aging of the world population, 22.1% was attributable to population growth, and total disability-adjusted life-years were attenuated by a 25.3% decrease in per capita IHD burden (decreased rate). The number of people living with nonfatal IHD increased more than the number of IHD deaths since 1990, but >90% of IHD disability-adjusted life-years in 2010 were attributable to IHD deaths. Conclusions Globally, age-standardized acute myocardial infarction incidence and angina prevalence have decreased, and ischemic heart failure prevalence has increased since 1990. Despite decreased age-standardized fatal and nonfatal IHD in most regions since 1990, population growth and aging led to a higher global burden of IHD in 2010.

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“…They were admitted for a presumptive diagnosis of ACS based on symptoms of acute ischaemia and at least one of the following: abnormal cardiac biomarkers, electrocardiogram (ECG) changes consistent with ACS and/or documented history of coronary artery disease [14,15]. Patients were diagnosed with ST-segment elevation myocardial infarction (STEMI) when they had new or presumed new ST-segment elevation ≥1 mm seen in any location, or new left bundle branch block on the index or subsequent electrocardiogram with at least 1 positive biomarker of myocardial necrosis [14,15]. Non-STEMI was defined as having at least 1 positive cardiac biomarker without new ST-segment elevation on the index ECG.…”

Section: Methodsmentioning

confidence: 99%

Pre-Hospital Cardiac Arrest in Acute Coronary Syndromes: Insights from the Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events

Goodman²,

Yan³

et al. 2013

Cardiology

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Objectives: Cardiac arrest in acute coronary syndromes (ACS) is associated with high morbidity and mortality. We examined the clinical characteristics, contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest. Methods: The Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events enrolled 14,010 ACS patients in 1999-2008. We compared the clinical characteristics, in-hospital treatment and outcomes between patients with and without pre-hospital cardiac arrest. Results: Overall, 206 (1.4%) patients had cardiac arrest prior to hospital presentation. ACS patients with pre-hospital cardiac arrest were less frequently treated with aspirin, β-blocker, angiotensin-converting enzyme inhibitors, and statins within the first 24 h of presentation, but the use of cardiac procedures was similar compared to the group without cardiac arrest. Patients with pre-hospital cardiac arrest had significantly higher rates of in-hospital adverse events. Factors independently associated with pre-hospital cardiac arrest included male gender, current smoker status, tachycardia, higher Killip class and ST-segment deviation. Conclusion: ACS patients with pre-hospital cardiac arrest continue to have more in-hospital complications and higher mortality. Their use of evidence-based medical therapies was lower but the use of cardiac procedures was similar compared to the group without cardiac arrest. Better utilization of evidence-based therapies in these patients may translate into improved outcomes.

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Cited by 518 publications

References 17 publications

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

The Global Burden of Ischemic Heart Disease in 1990 and 2010

Pre-Hospital Cardiac Arrest in Acute Coronary Syndromes: Insights from the Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events

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