Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up

Alnasser, Sami; Huang, Wei; Gore, Joel M.; Steg, Philippe Gabriel; Eagle, Kim A.; Anderson, Frederick A.; Fox, Keith A.A.; Gurfinkel, Enrique P.; Brieger, David; Klein, W.; Werf, Frans Van de; Avezum, Álvaro; Montalescot, Gilles; Gulba, Dietrich C.; Budaj, Andrzej; López‐Sendón, José; Granger, Christopher B.; Kennelly, Brian M.; Goldberg, Robert J.; Fleming, Emily; Goodman, Shaun G.

doi:10.1016/j.amjmed.2014.12.007

Cited by 94 publications

(75 citation statements)

References 33 publications

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“…In a series that reported on long-term outcomes, early mortality rate was often higher in STEMI patients, but by the end of one year, this was usually similar to or lower than in NSTE-ACS patients. 21 In our series, we noted a higher STEMI mortality rate, even at the end of one year. Also, the Kaplan-Meier survival estimates suggest a significantly higher STEMI mortality rate even beyond one year.…”

Section: Africasupporting

confidence: 46%

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

Varwani

Jeilan

Ngunga

et al. 2019

CVJA

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Background: Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking. was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events. Results: A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%. Conclusion: In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.

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Section: Africasupporting

confidence: 46%

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

Varwani

Jeilan

Ngunga

et al. 2019

CVJA

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“…Our study found 4.4% CV death, 9.0% nonfatal MI and 7.8% stroke during 24 months of post ACS. The higher recurrent event rates in our study could be associated with a higher percentage of patients with T2DM (43%) compared to 25% in GRACE since other patient characteristics and ACS treatment were similar between our study and GRACE [27]. Indeed, we found a higher composite endpoint (CV death, nonfatal MI, stroke) rate during 24 months post ACS in the patients with T2DM than those without (27 vs. 13%), which is consistent with the accumulated evidence that diabetes increases the risk of recurrent cardiovascular events post ACS [28–30].…”

Section: Discussionmentioning

confidence: 64%

“…A multinational study by the GRACE investigators [27] showed that CV death occurred in 4.1%, re-infarction in 4.4%, and stroke in 1.3% during 2 years of follow-up in 22,937 ACS patients from 57 sites. Our study found 4.4% CV death, 9.0% nonfatal MI and 7.8% stroke during 24 months of post ACS.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus

Neradilek

et al. 2017

Cardiovasc Diabetol

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BackgroundThe risk prediction of pregnancy-associated plasma protein-A (PAPP-A) for future cardiovascular (CV) events post acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM) was investigated in comparison to other risk factors.MethodsPAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2 years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events.ResultsACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p < 0.001) and higher rate of CV events 2 years post ACS (27.2 vs. 13.6%, p = 0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR = 2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11–4.18, p < 0.001] in T2DM and (HR = 3.16, 95% CI 2.27–4.39, p < 0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF < 50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model.ConclusionsPatients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2 years post ACS in patients with T2DM. Trial registration ISRCTN10805074. Registered on 20 January 2017, retrospectively registered.

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“…The decrease in long-term cardiac mortality has been partly attributed to declines in risk factors such as smoking and to the diffusion of procedural techniques [6,1,2], and the adjunctive therapies as the increase in the use of medical therapy for secondary prevention [17]. On the other hand the increasing trend of cancer and of other-cause death has been attributed to the older age of patients who are succumbing to cancer and other organ failure as respiratory, liver, and renal failure rather than to cardiac causes [1,2].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome and medical radiation exposure in patients hospitalized for cardiovascular disease

Carpeggiani

Rossi

Landi

et al. 2015

International Journal of Cardiology

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Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up

Cited by 94 publications

References 33 publications

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus

Long-term outcome and medical radiation exposure in patients hospitalized for cardiovascular disease

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