Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

Yin, Dean R P P Chan Pin; Azzahhafi, Jaouad; James, Stefan

doi:10.3390/jcm9093039

Cited by 23 publications

(15 citation statements)

References 74 publications

(108 reference statements)

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“…Acute coronary syndrome (ACS) constitutes the leading cause of morbidity and mortality worldwide [1,2]. Prospective risk stratification in patients with ACS, including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), facilitates decisions on the timing of angiography and thus enables a personalized therapeutic strategy [3,4]. Current American and European clinical guidelines suggest the use of a Global Registry of Acute Coronary Events (GRACE) risk score as a predictor of major adverse events in these patients [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

Sofidis

Otountzidis

Stalikas

et al. 2021

JCM

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The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE score in predicting the extent of CAD. A total of 539 patients with ACS undergoing coronary angiography were included in this analysis. The patients were classified into those with a SYNTAX score < 33 and a SYNTAX score ≥ 33. Spearman’s correlation and receiver operator characteristic analysis were conducted to investigate the role of the GRACE score as a predictor of the SYNTAX score. There was a significantly positive correlation between the SYNTAX and the GRACE scores (r = 0.32, p < 0.001). The GRACE score predicted severe CAD (SYNTAX ≥ 33) moderately well (the area under the curve was 0.595 (0.522–0.667)). A GRACE score of 126 was documented as the optimal cut-off for the prediction of a SYNTAX score ≥ 33 (sensitivity = 53.5% and specificity = 66%). Therefore, our study reports a significantly positive correlation between the GRACE and the SYNTAX score in patients with ACS. Notably, NSTEMI patients with a high-risk coronary anatomy have higher calculated GRACE scores. A multidisciplinary approach by a heart team could possibly alter the therapeutic approach and management in patients presenting with ACS and a high calculated GRACE score.

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Section: Introductionmentioning

confidence: 99%

Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

Sofidis

Otountzidis

Stalikas

et al. 2021

JCM

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“…Further improvement was the inclusion of additional clinical and anatomic variables resulting in the SYNTAX II score [14]. Although these scores were developed to estimate patient prognosis and to provide optimal patient-oriented treatment, they are still largely underused [20]. Some of the main concerns are their development and validation in different clinical settings, across the entire spectrum of both stable and unstable patients, managed with different treatment strategies [21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, their prognostic strength was evaluated in different time-frames, from in-hospital outcomes to short-term and long-term follow-up [6,19]. Finally, the complexity of risk scores aggravates everyday clinical usage indicating the importance of simple clinical scores [20].…”

Section: Resultsmentioning

confidence: 99%

ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

Kristić

Crnčević

Runjić

et al. 2021

BMC Cardiovasc Disord

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Background Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. Methods Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. Results During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05, P = 0.023 and HR 2.02, 95% CI 1.04–3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36–3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). Conclusions ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

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“…Original decision aid rule authors proposed managing the patient at the emergency department following the calculated risk. For example, safe discharge from the emergency department for low-risk groups, admission to the ward and invasive approach for high-risk groups, and additional examination such as serial troponin testing or stress/ imaging tests for moderaterisk groups [3]. Table 1 shows the summary of the selected decision aids.…”

Section: Decision Aid Rulesmentioning

confidence: 99%

Comparison of Six Decision Aid Rules For Diagnosis of Acute Myocardial Infarction In Elderly Patients Presenting To The Emergency Department With Acute Chest Pain

Hrečko

Dokoupil

Pudil

2021

Preprint

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Background: Using decision aid rules for diagnosis of acute myocardial infarction (AMI) is not common practice in our region. Elderly patients are often neglected in clinical trials, and the proper diagnostics of acute myocardial infarction in this group remains problematic. The objective of this study was to evaluate the accuracy and effectiveness of different strategies for the diagnosis of AMI in the elderly in real-life clinical practice. Methods: In a retrospective single-center study, we included patients older than 70 years presenting to the emergency department with chest pain as a dominant symptom. The performance of six decision aid rules (T-MACS, HEART, EDACS, TIMI, GRACE, and ADAPT) and solo troponin T strategy for diagnosing acute myocardial infarction was evaluated by calculating sensitivity, specificity, odds ratios, negative and positive predictive values.Results: A total of 250 patients, with a mean age of 78.5 years, were enrolled. Forty-eight patients (19.2%) had an acute myocardial infarction in a 30 day follow-up period. The sensitivity for ruling-out AMI was 100% for T-MACS, HEART, and ADAPT; 97.9% for EDACS, 93.8% for TIMI, and 81.3% for GRACE and solo TnT strategy. For ruling-in AMI, the specificity was 97.5% for T-MACS, 95% for TIMI, 83.2% for HEART, 81.7% for GRACE, and 46% for ADAPT. C-statistics were 0.52 for T-MACS, 0.51 for ADAPT, 0.47 for EDACS and GRACE, 0.46 for HEART and TIMI, and 0.33 for solo TnT strategy.Conclusion: T-MACS decision aid had the best performance with 100% sensitivity and 100% negative predictive value for rule-out AMI; 97.5% specificity and 64.3% positive predictive value for rule-in AMI. Other evaluated protocols were less accurate. Risk stratification of patients with suspected acute coronary syndrome based on decision aid rules can be used in real-life practice, even in the population of the elderly.

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Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

Cited by 23 publications

References 74 publications

Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

Comparison of Six Decision Aid Rules For Diagnosis of Acute Myocardial Infarction In Elderly Patients Presenting To The Emergency Department With Acute Chest Pain

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