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 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.

scholarly journals Risk Scores After Acute Coronary Syndrome

Angiology ◽  
2016 ◽  
Vol 68 (3) ◽  
pp. 185-188 ◽  
Author(s):  
Genovefa D. Kolovou ◽  
Niki Katsiki ◽  
Sophie Mavrogeni
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Judgment ◽  
Risk Scores ◽  
Aggressive Treatment ◽  
Future Studies ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Coronary Events ◽  
Global Registry

Acute coronary syndrome (ACS) is associated with both short- and long-term unfavorable prognosis. Therefore, medical societies developed risk scores for predicting mortality and assessing decision-making regarding early aggressive treatment in patients presenting an ACS. The Thrombolysis In Myocardial Infarction and the Global Registry of Acute Coronary Events risk scores are the most extensively investigated scores for ACS. Clinical judgment is also important. Significant differences in aggressive treatment of ACS still exist with respect to gender, age, and ethnicity. The reasons for these discrepancies need to be further elucidated in future studies. Therefore, generalizability of stratifications and risk scores in certain populations should be performed with caution.

scholarly journals In-hospital mortality in patients with NON-ST segment elevation myocardial infarction in relation to high risk global registry of acute cardiac events score.

2020 ◽  
Vol 27 (11) ◽  
pp. 2433-2437
Author(s):  
Ariz Samin ◽  
Syed Hassan Mustafa ◽  
Sajid Khan ◽  
Saamia Arshad ◽  
Noor ul Huda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Risk Scores ◽  
Outcome Variable ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Global Registry ◽  
Grace Score

Objectives: Presage for early risk stratification is consequential for long term clinical outcomes in patients with non-ST elevation acute coronary syndrome. Thrombolysis in Myocardial Infarction risk scores (TIMI) and Global Registry of Acute Cardiac Events (GRACE) have been most extensively investigated risk scores till date for risk stratification in patients admitted with Cardiovascular disease. Study Design: Descriptive Case Series. Setting: Department of Cardiology Ayub Teaching Hospital, Abbottabad. Period: 4th August 2016 to 4th April 2017. Material & Methods: 199 patients diagnosed with NSTEMI were included in the study after obtaining an apprised consent. Risk stratification of each patient was done according to GRACE score. Patients were followed up during their hospital stay and their outcome was recorded on a pre-designed pro forma. The outcome was described as either death or discharge. Results: Mean±SD GRACE score was 156.12±20.65. The overall mortality in the study population was 11.6% (n=23). When the outcome variable was stratified according to age, gender, diabetes mellitus, obesity and hypertension, results were found in case of hypertension (p< 0.05), and statistically no significant in the case of other variables. Conclusion: A high risk GRACE score is associated with increased in-hospital mortality in patients with NSTEMI.

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.

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