Abstract 255: Temporal Trends and Factors Associated with Referral for Cardiac Rehabilitation Post Acute Coronary Syndrome: Insights from the Canadian Global Registry of Acute Coronary Events (GRACE)

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Thang Nguyen ◽  
B.L. Abramson ◽  
Aaron Galluzzi ◽  
Mary Tan ◽  
Andrew T Yan ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Post Discharge ◽  
Referral Rates ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Younger Age ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Introduction: The beneficial effects of cardiac rehabilitation (CR) on morbidity and mortality after an acute coronary syndrome (ACS) are well established. Despite guidelines, CR referral rates have been low. Determining factors associated with CR referral would assist in closing this care gap and improve outcomes. Using the Canadian Global Registry of Acute Coronary Events (GRACE) database, we examined 1) the temporal trends of CR referral rates in Canada and its associated factors in a contemporary setting; 2) use of evidence-based medical therapies after ACS and its relationship with CR referral during index hospitalization. Hypothesis: CR referral rates have increased over time but remain below current guideline recommendations. Methods: From the Canadian GRACE registry, we retrospectively analyzed data from 11 Canadian centers during 2000 - 2007. CR referral rates were established and analyzed over time. We compared the CR Referral group to the Non-CR Referral group using univariate logistic regression in regards to patient characteristics, in-hospital diagnosis, clinical events and investigations. Categorical and continuous variables were compared using the chi-square and the Wilcoxon rank sum tests, respectively, with statistical significance at p<0.05. Data of guideline-recommended medication use at discharge and 6 months post-discharge were also analyzed. Results: In the 8-year period, 3338 patients (median age 64 years, 32% women) were assessed. Initial CR referral rate in 2000 was 2.7% (6/219) and increased to 51.2% (220/430) in 2007 (p<0.0001). Univariate factors for CR referral include younger age, larger infarct size, and a diagnosis of STE-ACS. Univariate factors for non-CR referral include CHF, higher GRACE score, and previous CAD. Hospitals with on-site supervised CR facilities had higher CR referral rates. CR Referral group had higher usage of evidence-based medications at time of discharge as well as 6 months post-discharge (all p< 0.0001). Conclusions: There has been a steady increase in CR referrals; however, contemporary numbers are still below the current recommendation of an 85% referral rate. Higher usage of recommended medications in the CR Referral group were noted, likely reflecting the association of CR referral with overall quality of care. Factors associated with CR referral include younger age, larger infarct size, and STE-ACS. Lack of referral was associated with CHF, previous CAD and high GRACE score. Targeting non-referred populations may improve quality of care and close care gaps in secondary prevention.

scholarly journals Incremental Prognostic Value of Biomarkers beyond the GRACE (Global Registry of Acute Coronary Events) Score and High-Sensitivity Cardiac Troponin T in Non-ST-Elevation Acute Coronary Syndrome

2013 ◽  
Vol 59 (10) ◽  
pp. 1497-1505 ◽  
Author(s):  
Christian Widera ◽  
Michael J Pencina ◽  
Maria Bobadilla ◽  
Ines Reimann ◽  
Anja Guba-Quint ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Model Performance ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Coronary Events ◽  
Incremental Prognostic Value ◽  
Global Registry ◽  
Grace Score

BACKGROUND Guidelines recommend the use of validated risk scores and a high-sensitivity cardiac troponin assay for risk assessment in non-ST-elevation acute coronary syndrome (NSTE-ACS). The incremental prognostic value of biomarkers in this context is unknown. METHODS We calculated the Global Registry of Acute Coronary Events (GRACE) score and measured the circulating concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and 8 selected cardiac biomarkers on admission in 1146 patients with NSTE-ACS. We used an hs-cTnT threshold at the 99th percentile of a reference population to define increased cardiac marker in the score. The magnitude of the increase in model performance when individual biomarkers were added to GRACE was assessed by the change (Δ) in the area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), and category-free net reclassification improvement [NRI(&gt;0)]. RESULTS Seventy-eight patients reached the combined end point of 6-month all-cause mortality or nonfatal myocardial infarction. The GRACE score alone had an AUC of 0.749. All biomarkers were associated with the risk of the combined end point and offered statistically significant improvement in model performance when added to GRACE (likelihood ratio test P ≤ 0.015). Growth differentiation factor 15 [ΔAUC 0.039, IDI 0.049, NRI(&gt;0) 0.554] and N-terminal pro–B-type natriuretic peptide [ΔAUC 0.024, IDI 0.027, NRI(&gt;0) 0.438] emerged as the 2 most promising biomarkers. Improvements in model performance upon addition of a second biomarker were small in magnitude. CONCLUSIONS Biomarkers can add prognostic information to the GRACE score even in the current era of high-sensitivity cardiac troponin assays. The incremental information offered by individual biomarkers varies considerably, however.

Predicting Outcome in Patients with Acute Coronary Syndrome: Evaluation of B-Type Natriuretic Peptide and the Global Registry of Acute Coronary Events (GRACE) Risk Score

2007 ◽  
Vol 52 (3) ◽  
pp. 8-13 ◽  
Author(s):  
H. Sinclair ◽  
M Paterson ◽  
S. Walker ◽  
G Beckett ◽  
K.A.A. Fox
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Risk Scores ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Clinical Risk ◽  
St Elevation ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Background Accurate risk stratification soon after admission for patients with acute coronary syndromes (ACS) is vital in guiding management. Clinical risk scores and B-type natriuretic peptide (BNP) can predict mortality and re-infarction in ACS, but it is unknown whether BNP provides prognostic information over and above that of the clinical risk scores. Methods 142 unselected patients with ACS were prospectively studied. BNP was measured and patients were stratified according to BNP and Global Registry of Acute Coronary Events (GRACE) score. In-hospital and 30-day events were characterised. Results 20.4% of ACS subjects had ST-elevation myocardial infarction (MI), 14.1%, non-ST elevation MI and 65.5% unstable angina. Elevated BNP predicted inhospital and 30-day heart failure (p<0.01), and the risk of in-hospital recurrent ACS (p<0.05). Increasing GRACE score predicted in-hospital recurrent ACS (p<0.05), heart failure (p<0.001), arrhythmias (p<0.05) and angioplasty (p<0.05). GRACE score also predicted 30-day heart failure (p<0.05). In contrast, the predictive accuracy of troponin elevation was less robust. Conclusion BNP and the GRACE score predict complementary outcomes from ACS, but both predicted heart failure. BNP is a powerful indicator of heart failure in patients with ACS and provides prognostic information above and beyond conventional biomarkers and risk scores.

scholarly journals Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction

2020 ◽  
Author(s):  
John Hung ◽  
Andreas Roos ◽  
Erik Kadesjö ◽  
David A McAllister ◽  
Dorien M Kimenai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Receiver Operating Curve ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Abstract Aims The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. Methods and results In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong’s test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82–0.85] and 0.85 (95% CI 0.81–0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70–0.77) and 0.73 (95% CI 0.66–0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P &lt; 0.001 and P = 0.008, respectively). Conclusion The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. Trial registration ClinicalTrials.gov number, NCT01852123.

scholarly journals Association of Neutrophil Lymphocyte Ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) Scores in Acute Coronary Syndrome

2020 ◽  
Vol 2 (3) ◽  
pp. 162-170
Author(s):  
Baginda Yusuf Siregar ◽  
Refli Hasan ◽  
Rahmad Isnanta
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Design Data ◽  
Cross Sectional ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Background. Inflammation plays an important role in the initiation of atherosclerosis from the beginning of plaque to rupture cause Acute Coronary Syndrome (ACS). Neutrophil Lymphocyte Ratio (NLR) indicator of systemic inflammation in ACS. Risk stratification was needed for assessment and selection of initial invasive strategies and find the best strategy in ACS. The Global Registry of Acute Coronary Events (GRACE) scores recommended risk stratification of ACS. Aims of the study to determine the association and cut-off value NLR with risk stratification GRACE score. Method. This study is analytical with a cross-sectional retrospective design. Data were analyzed after distribution test, then mean difference and correlation test was using the SPPS program where p <0.05 was considered statistically significant. Results. This study showed significantly higher NLR value in the high risk stratification and intermediate-risk compared to low risk stratification (7.9 ± 2.7 vs 3.6 ± 1.7; p=0.001) (5.2 ± 2.3 vs 3.6 ± 1.7; p=0.018). Significant correlation between NLR ​​with GRACE scores (r=0.570; p<0.001). Significant AUC values ​​were obtained (0.782, p <0.001, IK95% 0.674-0.89), and cut-off values NLR 4 ​​with sensitivity (78.8%) and specificity (70.3%) on the GRACE score. Conclusion. The significant association between NLR ​​with GRACE risk score in ACS.

scholarly journals Association between serum S100A1 level and Global Registry of Acute Coronary Events score in patients with non-ST-segment elevation acute coronary syndrome

2018 ◽  
Vol 46 (7) ◽  
pp. 2670-2678
Author(s):  
Yuanmin Li ◽  
Chenjun Han ◽  
Peng Zhang ◽  
Wangfu Zang ◽  
Rong Guo
Keyword(s):  
Acute Coronary Syndrome ◽  
Venous Blood ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
St Segment ◽  
Potential Biomarker ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Objective Acute coronary syndrome (ACS) is associated with several clinical syndromes, one of which is acute non-ST-segment ACS (NSTE-ACS). S100A1 is a calcium-dependent regulator of heart contraction and relaxation. We investigated the association between the serum S100A1 level and the Global Registry of Acute Coronary Events (GRACE) risk score in patients with NSTE-ACS and the potential of using the serum S100A1 level to predict the 30-day prognosis of NSTE-ACS. Methods The clinical characteristics of 162 patients with NSTE-ACS were analyzed to determine the GRACE score. The serum S100A1 concentration was determined using fasting antecubital venous blood. The patients were divided into different groups according to the serum S100A1 level, and the 30-day NSTE-ACS prognosis was evaluated using Kaplan–Meier analysis. Results The serum S100A1 levels differed significantly among the groups. Correlation analysis showed that the serum S100A1 level was positively correlated with the GRACE score. Kaplan–Meier analysis revealed that the number of 30-day cardiac events was significantly higher in patients with an S100A1 level of >3.41 ng/mL. Conclusions S100A1 is a potential biomarker that can predict the progression of NSTE-ACS and aid in its early risk stratification and prognosis.

scholarly journals Association of Platelet Lymphocyte Ratio (PLR) and Neutrophil Lymphocyte Ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) Score in Acute Coronary Syndrome

2021 ◽  
Vol 8 (5) ◽  
pp. 1-6
Author(s):  
Baginda Yusuf Siregar ◽  
Refli Hasan ◽  
Rahmad Isnanta
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Risk Stratification ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Platelet Lymphocyte Ratio ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Introduction: Acute Coronary Syndrome (ACS) has morbidity and mortality significantly increase, it requires risk stratification for the assessment and selection of initial invasive strategies. The Global Registry of Acute Coronary Events (GRACE) scores recommended as risk stratification of ACS. Some of studies found that the combination of GRACE scores with other clinical and laboratory parameters can increase predictive value of ACS. Platelet Lymphocyte Ratio (PLR) and Neutrophil Lymphocyte Ratio (NLR) act as parameter of systemic inflammation in ACS. Aims of the study to determine the association between PLR and NLR with risk stratification GRACE score. Method: This study is analytical with a cross-sectional retrospective design. This study included 70 patients with a diagnosis of ACS based on medical record data. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) 22.0. P-value <0.05 was considered statistically significant. Results: This study was found a positive correlation between PLR and NLR with the GRACE score of patients ACS (r=0.485, p<0.001; r=0.570, p<0.001). The PLR and NLR were both found the significantly higher in the high risk GRACE score respectively (188 ± 47, p < 0.001; 7.9± 2.7, p<0.001). The ROC curve analysis, cutt-off PLR of 123 and above (sensitivity of 72.7 %; specificity of 70.3), while cutt-off NLR of 4 and above (sensitivity of 78.8%; specificity of 70.3%) to detect high risk GRACE score. Conclusion: There is a significant association between PLR and NLR with GRACE score Keywords: Platelet Lymphocyte Ratio, Neutrophil Lymphocyte Ratio, GRACE score, Acute Coronary Syndrome.

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