Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events

Brieger, David; Fox, Keith A.A.; FitzGerald, Gordon; Eagle, Kim A.; Budaj, Andrzej; Avezum, Álvaro; Granger, Christopher B.; Costa, B.; Anderson, Fred; Steg, Philippe Gabriel

doi:10.1136/hrt.2008.153387

Cited by 75 publications

(52 citation statements)

References 40 publications

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“…Recent data describe models to predict absence of major adverse cardiac events among patients diagnosed with non-ST elevation myocardial infarction-ACS. 37 But these analyses are predicated on physicians recognizing with a high degree of accuracy that the patient is experiencing an ACS event. Without accurate probability prediction by physicians, risk stratification to predict major adverse cardiac outcomes becomes problematic.…”

Section: Discussionmentioning

confidence: 99%

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Lee

Hoffmann²,

Bamberg³

et al. 2012

CJEM

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Introduction: Little information exists regarding how accurately emergency physicians (EPs) predict the probability of acute coronary syndrome (ACS). Our objective was to determine if EPs can accurately predict ACS in a prospectively identified cohort of emergency department (ED) patients who met enrolment criteria for a study of coronary computed tomographic angiography (CCTA) and were admitted for a ''rule out ACS'' protocol. Methods: A prospective observational pilot study in an academic medical centre was carried out. EPs caring for patients with chest pain provided whole-number estimates of the probability of ACS after clinical review. This substudy was part of the now published Rule Out Myocardial Infarction/ Ischemia Using Computer Assisted Tomography (ROMICAT) study, a study of CCTA and admission of patients for a rule out ACS protocol after a nondiagnostic evaluation. Predictions were grouped into probability groups based on the validated Goldman criteria. ACS was determined by an adjudication committee using American Heart Association/American College of Cardiology/European Society of Cardiology guidelines. Results: A total of 334 predictions were obtained for a study population with a mean age of 54 (SD 12) years, 63% of whom were male. There were 35 ACS events. EPs predicted ACS better than by chance, and increasingly higher estimates were associated with a higher incidence of ACS (p 5 0.0004). The percentage of patients with ACS was 0%, 6%, 7%, and 17%, respectively, for very low, low, intermediate, and high probability groups. EPs' estimates had a sensitivity of 63% using a . 20% probability of ACS to define a positive test. Lowering this threshold to . 7% to define a test as positive increased the sensitivity of physician estimates to 89% but lowered specificity from 65% to 24%.

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Section: Discussionmentioning

confidence: 99%

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Lee

Hoffmann²,

Bamberg³

et al. 2012

CJEM

View full text Add to dashboard Cite

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“…The main in-hospital outcome of acute coronary syndrome includes death, stroke, major bleeding, arrhythmia, and heart failure [6].…”

Section: Resultsmentioning

confidence: 99%

“…In the Global Registry of Acute Coronary Events (GRACE) of patients with non ST segment elevation ACS, the rates of in-hospital outcome heart failure or shock, MI, major bleeding or stroke were 10, 2.4, 1.8 and 0.5%, respectively [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt

El-Adawy¹

2017

CMR

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Cardiovascular problems are still the leading cause of deaths globally. Socioeconomic inequality continues to pose a challenge to health care suppliers and can greatly affect the clinical outcome of medical problems, especially in the cardiovascular field. This study aimed to assess the in-hospital outcome of patients with acute coronary syndrome admitted in the coronary care unit and to determine the relation between socioeconomic status (SES) and in-hospital outcome of acute coronary syndrome. A prospective observational study was conducted on 301 patients presented with acute coronary syndrome during the period from August 2015 to May 2016. A questionnaire was used to assess their socioeconomic status. Admitted patients with acute coronary syndrome (ACS) were classified into 31 (10.3%) patients with non-ST segment elevation myocardial infarction (NSTEMI), 162 (53.8%) with ST segment elevation myocardial infarction STEMI and 108 (35.9%) with unstable angina (UA). According to patients SES, they were classified as 77 with high SES, 74 with middle SES, 84 with low SES, and 66 with very low SES. The study revealed that the lower socioeconomic status was statistically significant associated with increase of acute coronary syndrome mortality (P <0.001), the incidence of impaired left ventricular function, heart failure and stroke was associated. While, lower socioeconomic status was significantly associated decrease in the incidence of coronary angiography and percutaneous intervention. No significant change in the incidence of arrhythmia and major bleeding between socioeconomic status classes. Lower socioeconomic status in patients with acute coronary syndrome was considered as a risk factor for increased in-hospital mortality, stroke, impaired left ventricular function, and heart failure. To the best of author's knowledge, this study considered first report in Egypt discussing the in-hospital outcome of patients with ACS and to determine the relation between SES and in-hospital outcome of ACS patients.

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“…Pored TIMI, GRACE rizik skor je široko primenjivan za intrahospitalni mortalitet i mortalitet nakon 6 meseci, kao i za druge hospitalne neželjene događaje: novi infarkt miokarda, aritmije, kongestivnu srčanu insuficijenciju ili šok, masivno krvarenje, šlog 11,12 . U našoj studiji je pokazana značajna povezanost između ukupnih kardiovaskularnih događaja (MACE: smrtni ishod, VT, VF, ReIM, SI) i TIMI rizik skora u jednogodišnjem periodu praćenja (p<0,01).…”

Section: U Essence (Efficacy and Safety Of Subcutaneousunclassified

The importance of TIMI risk score in patients with acute myocardial infarction with ST segment elevation

Krljanać¹,

Vasiljević²,

Mrdović³

et al. 2012

Srce i krvni sudovi

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Uvod Pacijenti sa akutnim koronarnim sindromom (AKS) su heterogena populaciju sa velikom varijabilnošću rizika za pojavu neželjenih kardiovaskularnih događaja kako u ranom tako i u dugoročnom periodu praćenja 1 . Uključeni u kliničke studije, pacijenti sa AKS se mogu prema rizik skoru kvantifikovati u podgrupe koje su pogodne za međusobno poređenje 2 . Sa pojavom novih terapijskih mogućnosti javila se posebna potreba za stratifikacijom bolesnika sa akutnim koronarnim sindromom (AKS).Za ranu prognozu ovih pacijenata, pored osnovnih faktora rizika kao što su godine starosti, pol, pušenje, hiperholesterolemija, hipertenzija, dijabetes, bubrežne insuficijencije i drugi komorbiditeti, inicijalna klinička prezentacija ima visoku prediktivnu vrednost 3 . Tahikardija, hipotenzija, ili srčana insuficijencija pri prijemu ukazuju na lošu prognozu i zahtevaju brzu dijagnozu i lečenje. Kao značajan prediktor smrtnog ishoda kod bolesnika sa infarktom miokarda sa ST elevacijom (STEMI), primenjuje se TIMI rizik skor (Thrombolysis in myocardial infarction) koji je klinički rizik skor, jednostavan za izračunavanje na osnovu godina starosti, faktora rizika, kliničke prezentacije bolesnika, promena u elektrokardiogramu (EKG) i vremena koje je proteklo od početka simptoma 4 . Pored kratkoročnog, TIMI rizik skor može se koristiti i za procenu dugoročnog ishoda STEMI bolesnika, a u nekom prethodnom periodu, pre 10-ak godina, koristio se i za trijažu bolesnika pogodnih za primenu fibrinolitčke terapije 5 . Primarni cilj rada je procena da li je TIMI rizik skor kod naših bolesnika sa STEMI značajan prediktor lošeg ishoda u toku prvih mesec dana i u toku prvih godinu dana praćenja. Sekundarni cilj rada je korelacija TIMI skora sa ejekcionom frakcijom (EF), wall motion skor indeksom (WMSI) i veličinom infarkta kod istih bolesnika u ranom postinfarktnom periodu. Medicinski fakultet, Univerzitet u BeograduUvod: Prognoza bolesnika sa akutnim koronarnim sindromom (AKS) može se određivati na osnovu TIMI rizik skora, koji je jedan od lako primenjivih skorova za kvantitativnu procenu rizika bolesnika. Primarni cilj rada je procena da li je TIMI rizik skor kod naših bolesnika sa STEMI značajan prediktor lošeg ishoda nakon mesec dana i nakon godinu dana praćenja. Sekundarni cilj rada je korelacija TIMI skora sa ejekcionom frakcijom (EF), wall motion skor indeksom (WMSI) i veličinom infarkta kod istih bolesnika u ranom postinfarktnom periodu. Metodi: Studija je obuhvatila 115 bolesnika sa STEMI, starosti 56.6 ± 10.2 godina, 79 muškaraca i 36 žena, koji su lečeni u Koronarnoj jedinici KCS. Kod svih bolesnika izračunat je TIMI rizik skor za procenu rizika na osnovu: starosti pacijenta, prethodnih faktora rizika (dijabetes, hipertenzija i angina pektoris), sistolnog krvnog pritiska i srčane frekvence pri prijemu, Killip klase, telesne težine bolesnika, postojanja ST elevacije na prednjem zidu ili bloka leve grane i vremena od početka simptoma. Ehokardiografski pregled je rađen u prvih nedelju dana infarkta miokarda kada su se određivali parametri EF ...

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Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events

Abstract: The GRACE Freedom-from-Event score can predict the in-hospital course of NSTE-ACS, and identifies up to 30% of the admitted population at low risk of death or any adverse in-hospital event.

Cited by 75 publications

References 40 publications

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt

The importance of TIMI risk score in patients with acute myocardial infarction with ST segment elevation

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