scholarly journals The value of GRACE risk score for predicting mortality in heart failure patients admitted with non-ST elevation acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Bouzas Cruz ◽  
A Cordero ◽  
B Alvarez-Alvarez ◽  
V Bertomeu-Gonzalez ◽  
T Gonzalez-Ferrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Score ◽  
Model Performance ◽  
Kidney Injury ◽  
Killip Class ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
St Elevation ◽  
Grace Score

Abstract Background Acute coronary syndrome (ACS) in heart failure (HF) patients has not been well studied yet. Purpose The main aims of this study were to compare the characteristics and outcomes of Non-ST elevation ACS (NSTACS) in patients with and without prior HF, and to assess the GRACE risk score performance for risk stratification in both groups. Methods All consecutive patients (n=5661) admitted due to a NSTACS from November'2003 to November'2017 in two Spanish hospitals were retrospectively analysed. Patients were divided according to prior HF. As GRACE score predicts mortality in 6 months, logistic regression models were used to predict mortality in both groups. The different aspects of model performance were studied, including calibration and discrimination. Results Killip class, GRACE and CRUSADE scores were higher in HF-patients compared to patients without prior HF. Also, HF-patients had more complications (major bleeding, worsening HF, acute kidney injury) and higher mortality. Discrimination capacity of GRACE score to predict mortality at 6 months was slightly higher in non-HF patients (AUC 83.9% [81.6–86.2]) than in HF-patients [AUC 77.0% [70.1–83.8]) (Figure 1). The risk score calibration was acceptable for both groups [Brier scores were 0.139 (c-AUC 0,77) for HF-patients, and 0.046 (c-AUC 0.839) for non-HF patients]. Finally, HF-patients with lower GRACE scores had a higher predicted mortality than non-HF patients (Table 1). Conclusions We showed the potential utility of GRACE risk score in HF-patients admitted with NSTACS, expanding the indication of GRACE risk score for HF-patients as well. In fact, GRACE risk score not only keeps its accuracy, but it is even more robust in HF-patients than in non-HF patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Table 1

scholarly journals The value of the Global Registry of Acute Coronary Events and Gensini scores in predicting long-term outcomes in Vietnamese patients with non-ST-elevation acute coronary syndrome

2021 ◽  
Vol 8 (2) ◽  
pp. 4233-4240
Author(s):  
Sy Van Hoang ◽  
Kha Minh Nguyen ◽  
An Hoang Nguyen ◽  
Khoa Le Anh Huynh ◽  
Hai Phuong Nguyen Tran
Keyword(s):  
Risk Score ◽  
Gensini Score ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
St Elevation ◽  
Coronary Events ◽  
Artery Disease ◽  
Grace Score

Introduction: Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) should undergo risk stratification as soon as possible after their presentation. Early risk satisfaction provides good prognosis for patients as well as better decision for reperfusion therapy. The aim of this study is to find a correlation between the Global Registry of Acute Coronary Events (GRACE) risk score and severity of coronay artery disease assessed by Gensini score score and compare the value of GRACE and Gensini scores in predicting the long-term outcomes in patients with NSTE-ACS. Methods: A total of 220 patients with NSTE-ACS who underwent coronary angiography were enrolled in our study. The Gensini score was used to assess the severity of coronary artery disease. According to the GRACE score, the patients were grouped into low, intermediate and high groups. After 30 months of follow-up, 20 patients died. Results: The mean Gensini scores were 11.8 ± 11.5, 27.4 ± 30.9, and 42.9 ± 29.7 in the low, intermediate and high-risk groups, respectively. The GRACE scores and Gensini score had a moderate positive correlation (rho = 0.522, p < 0.001). The survival rates showed a less rapid deterioration from the low to high GRACE groups (P = 0.013) than when classified according to their Gensini tertiles (P = 0.02). Area under the ROC curve was statistically significant for both scores, but area of the GRACE risk score (0.71; 95% Cl = 0.60 - 0.82) was higher than that the Gensini risk score (0.66; 95% Cl = 0.53 – 0.80). Conclusion: Our study revealed that the Gensini score had a positive and significant relationship with the GRACE score in patients with NSTE-ACS. The GRACE score had a more value in predicting long-term outcomes in patients with NSTE-ACS.

scholarly journals Impact of Admission Blood Glucose Added on GRACE Risk Score for All-Cause In-Hospital Mortality in Patients with Acute Coronary Syndrome

2018 ◽  
Vol 33 (2) ◽  
pp. 94-99
Author(s):  
Md Mesbahul Islam ◽  
Mohsin Ahmed ◽  
Mohammad Ali ◽  
Abdul Wadud Chowdhury ◽  
Khandakar Abu Rubayat
Keyword(s):  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Hospital Mortality ◽  
Blood Sugar ◽  
Risk Score ◽  
Hospital Death ◽  
Predictive Values ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
Grace Score

Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. Objectives: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p <0.05 was considered to be statistically significant. Results: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (<11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610). Conclusion: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the established risk factors with the GRACE risk score. Bangladesh Heart Journal 2018; 33(2) : 94-99

scholarly journals Prognostic relevance of GRACE risk score in Takotsubo syndrome

2019 ◽  
Vol 9 (7) ◽  
pp. 721-728 ◽  
Author(s):  
Fernando Scudiero ◽  
Luca Arcari ◽  
Luca Cacciotti ◽  
Elena De Vito ◽  
Rossella Marcucci ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Grace Score

Background: Takotsubo syndrome is an increasingly recognised cardiac condition that clinically mimics an acute coronary syndrome, but data regarding its prognosis remain controversial. It is currently unknown whether acute coronary syndrome risk scores could effectively be applied to Takotsubo syndrome patients. This study aims to assess whether the Global Registry of Acute Coronary Events (GRACE) score can predict clinical outcome in Takotsubo syndrome and to compare the prognosis with matched acute coronary syndrome patients. Methods: A total of 561 Takotsubo syndrome patients was included in this prospective registry. According to the GRACE score, the population was divided into quartiles. The primary endpoint was all-cause mortality and the secondary endpoints were cardiocerebrovascular events (a composite of all-cause mortality, cardiovascular death, recurrence of Takotsubo syndrome and stroke). Results: The median GRACE risk score was 139±27. Takotsubo syndrome patients with a higher GRACE risk score mostly have a higher rate of physical triggers and lower left ventricular ejection fraction on admission. During long-term follow-up, all-cause mortality rates were 5%, 11%, 12% and 22%, respectively, in the first, second, third and fourth quartile ( P<0.001). After multivariate analysis, the GRACE risk score was found to be a strong predictor of all-cause mortality (odds ratio (OR) 1.68, 95% confidence interval (CI) 1.28–2.20; P=0.001) and cardiocerebrovascular events (OR 1.63, 95% CI 1.26–2.11; P=0.001). Moreover, all-cause mortality in Takotsubo syndrome patients was comparable with the matched acute coronary syndrome cohort. Conclusion: In Takotsubo syndrome, the GRACE risk score allows us to predict all-cause mortality and cardiocerebrovascular events at long-term follow-up.

scholarly journals Risk stratification for the development of heart failure after acute coronary syndrome at the time of hospital discharge: Predictive ability of GRACE risk score

2015 ◽  
Vol 66 (3) ◽  
pp. 224-231 ◽  
Author(s):  
Sergio Raposeiras-Roubín ◽  
Emad Abu-Assi ◽  
Andrea López-López ◽  
Noelia Bouzas-Cruz ◽  
María Castiñeira-Busto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Hospital Discharge ◽  
Risk Score ◽  
Predictive Ability ◽  
Coronary Syndrome ◽  
Grace Risk Score

scholarly journals Mortality Rate and Its Associated Factors in Patients with Non ST-Elevation-Acute Coronary Syndrome in Bali: Results from A Single Center Registry

2018 ◽  
Vol 11 (4) ◽  
pp. 1895-1901
Author(s):  
I Made Junior Rina Artha ◽  
I Made Pande Dwipayana
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Risk Score ◽  
Associated Factors ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
St Elevation

Non-ST elevation – acute coronary syndrome (NSTE-ACS) consisted of non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) diagnoses, which are common cardiac events in Indonesia, including Bali. To evaluate in-hospital mortality and its associated factors in patients with NSTE-ACS patients in the Province of Bali. This was a cross-sectional study using data from ACS 2016 registry in Bali. Subjects were adult ACS patients who were hospitalized in Sanglah General Hospital (SGH), Denpasar, Bali Island. Diagnosis of ACS was grouped into NSTEMI and UAP. Demography, clinical data, and anticoagulant treatment were analyzed. Clinical outcome was in-hospital mortality. A total of 421 NSTE-ACS patients were diagnosed; 300 (71.3%) among them were men. Patients’ mean age was 59 + 12.0 years. Diagnoses were UAP in 260 (61.8%) and non-STEMI in 161 (38.2%) cases. Heparin treatment was given to 409 (97.1%) patients, consisted of 96 (22.8%) unfractionated heparin (UFH), 177 (42.0%) fondaparinux, and 136 (32.3%) enoxaparin. There were 8 (1.9%) patients who underwent early PCI. The overall mortality rate of NSTE-ACS patients was 6.4%; it was higher in NSTEMI than UAP patients (13.0% vs. 2.3%; p<0.001; OR = 6.350; 95% CI = 2.504 – 16.101). Components of GRACE risk score and a score of >140 were risk factor for in-hospital death. Mortality rate was 12.5% with heparin therapy, 6.6% in patients treated with enoxaparin, and 2.3% in patients receiving fondaparinux. GRACE risk score is the only independent risk factor of death. Mortality of NSTE-ACS patients is still high (6.4%). High GRACE score is a significant risk factor of in-hospital death. The use of fondaparinux as anticoagulant agent may improve survival. Further studies are needed to confirm this finding.

scholarly journals What factors are Associated with the Development of Contras-induced Nephropathy in Elderly Patients with Acute Coronary Syndrome in Real Clinical Practice?

2020 ◽  
Vol 16 (6) ◽  
pp. 908-915
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova ◽  
P. V. Kovalets ◽  
A. V. Slivin ◽  
A. E. Udovichenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Medical Records ◽  
Kidney Injury ◽  
Killip Class ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome

Aim. To study the factors associated with contrast-induced acute kidney injury in elderly patients with acute coronary syndrome (ACS).Material and Methods. A retrospective analysis of 514 electronic medical records of patients aged 75 years and over (38% men and 62% women) with confirmed acute coronary syndrome has been performed. The contrast-induced acute kidney injury was defined as an increase in serum creatinine ≥26.5 μmol/L in 48 h or as an increase in serum creatinine in 1.5 times within 7 days after the contrast media exposure. Patients were divided into contrast-induced acute kidney injury and non-contrast-induced acute kidney injury group. Clinical characteristics and in-hospital outcomes were extracted from patients' medical records. Procedural characteristics were obtained from laboratory database.Results. Angiographic intervention was performed in 74% of patients, 32% of them (more often in women, p=0.033) were diagnosed with contrast-induced acute kidney injury. Patients with contrast-induced acute kidney injury are characterized by a higher death rate (17% и 3%, p<0.001) and were more likely to have heart failure with reduced ejection fraction (34% и 21%, p=0.008) and acute heart failure (Killip class II-IV) (24% и 16%, p=0.015). The risk of developing contrast-induced acute kidney injury was related the volume of contrast medium administered.Conclusions. Prevention particular care should be taken to female patients older than 75 years with ACS, with a history of the chronic heart failure with reduced ejection fraction or acute heart failure (Killip class II-IV), and with a high volume of contrast media, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.

scholarly journals Acute Coronary Syndrome in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Artery Disease

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P&lt;0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P &lt;0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P &lt;0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P &lt;0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

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