scholarly journals Clinical Application of Grace Risk Score in Patients with Acute Coronary Syndrome

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Samar Firdous ◽  
Uzma Malik
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Clinical Application ◽  
Risk Score ◽  
Adverse Outcomes ◽  
Cardiac Biomarkers ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
The Mean

Objectives:  To determine clinical application of GRACE risk score in patients with acute coronary syndrome (ACS).Patients and Methods:  It was an observational analytical study conducted in the Cardiology ward of Mayo hospital, Lahore from April to July 2015. Patients with Acute STEMI, NSTEMI or Unstable angina (UA) were selected on the basis of typical chest pain, ECG changes or cardiac biomarkers .For all eligible cases, at presentation GRS was calculated using online calculator. Also, GRACE risk categories and predicted in-hospital mortality were determined. Patients with previous episodes of STEMI/ NSTEMI, old Left Bundle Branch Block (LBBB), stable angina pectoris, acute pericarditis, myocarditis, acute rheumatic fever or pulmonary embolism were excluded. Data was analyzed on SPSS 20 and the R project for statistical computing. Individual components of GRS were compared among discharged and expired cases using t-test. A p-value of <0.05 was considered significant.Results:  A total of 165 patients with STEMI and ACS were included. The mean GRS among males andfemales was 137.4 ± 39 and 151.5 ± 50.6. The observed in-hospital mortality was 12.12% with 60% patients of STEMI. Among expired cases, 90% patients had high GRS, predominantly from STEMI group. Important determinants of adverse outcome were advanced age, tachycardia, low systolic blood pressure and presence of cardiac failure.Conclusion:  STEMI was the major acute cardiac event. The mean GRS of expired patients was significantly higher than discharged group. GRS accurately identified low risk cases with low probability of in-hospital death. GRS over estimate probability of in-hospital death among STEMI high risk cases that had higher scores and discharged uneventfully. Grace Risk Score is a reliable predictor of risk category and adverse outcomes and its use by clinicians should be strongly recommended.

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 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 GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome

2017 ◽  
Vol 244 ◽  
pp. 24-29 ◽  
Author(s):  
Inna Y. Gong ◽  
Shaun G. Goodman ◽  
David Brieger ◽  
Chris P. Gale ◽  
Derek P. Chew ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Risk Score ◽  
Mortality Prediction ◽  
Coronary Syndrome ◽  
Grace Risk Score

scholarly journals Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Centola ◽  
A Maloberti ◽  
S Persampieri ◽  
D Castini ◽  
N Morici ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Prognostic Value ◽  
Risk Model ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Incremental Prognostic Value ◽  
Grace Score

Abstract Background Hyperuricemia has been associated with high mortality rates in patients with acute myocardial infarction. The role and the prognostic relevance of increased serum uric acid (SUA) in patients with acute coronary syndrome (ACS) are still under debate Aim We sought to assess the association between elevated admission levels of SUA and in-hospital adverse outcomes in a real-world patient population with ACS and to investigate the potential incremental prognostic value of SUA added to GRACE score Methods 1088 consecutive patients admitted with a diagnosis of ACS to the Coronary Care Unit of two Hospitals were enrolled. Medical history, clinical characteristic, biochemical and electrocardiographic findings, angiographic data, treatments administered during hospitalization were all collected on an electronic database. All patients' data were entered prospectively in the database of the two hospitals and retrospectively analysed. Results The mean age was 68 years (IQR 60–78). Less than one-third of the total population was female (24%). Diabetes mellitus was present in 308 (28%) patients. The proportion of patients with STEMI and NSTEMI/UA was quite similar: 504 (46%) patients had a diagnosis of STEMI and 584 (54%) patients had a diagnosis of NSTEMI/UA. The GRACE score was 133 (IQR 112–156). In-hospital mortality rate was 2.3% in the overall population. Two variables were associated with a significantly increased risk of in-hospital death at the multivariate analysis: SUA (OR 1.72 95% CI 1.33–2.22, p&lt;0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p&lt;0.0001). To investigate the potential incremental prognostic value of SUA added to GRACE score for in-hospital death, we analyzed the results of adding hyperuricemia as categorical variable to the original GRACE risk model (GRACE-SUA score). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89–0.93, p&lt;0.0001) and 0.79 (95% CI 0.76–0.81, p&lt;0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93–0.95; p&lt;0.0001). The addition of hyperuricemia to the GRACE score led to reclassifying 18 of 211 (8.5%) patients without in-hospital deaths from high to low risk. No patients with o without events were incorrectly reclassified. The net-reclassification index (NRI) of the GRACE-SUA score was 1.7% (z value of 4.3; p&lt;0.001). Conclusions High admission levels of SUA are positively and independently associated with in-hospital adverse outcomes and mortality in a contemporary and unselected population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality and to improve risk classification in this study population. Funding Acknowledgement Type of funding source: None

scholarly journals Exploring Triaging and Short-Term Outcomes of Early Invasive Strategy in Non-ST Segment Elevation Acute Coronary Syndrome: A Report from Japanese Multicenter Registry

2020 ◽  
Vol 9 (4) ◽  
pp. 1106
Author(s):  
Nobuhiro Ikemura ◽  
Yasuyuki Shiraishi ◽  
Mitsuaki Sawano ◽  
Ikuko Ueda ◽  
Yohei Numasawa ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Risk Score ◽  
Mortality Risk ◽  
Adverse Outcomes ◽  
Invasive Strategy ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Elevation Acute Coronary Syndrome ◽  
Early Invasive Strategy

This observational study aimed to examine the extent of early invasive strategy (EIS) utilization in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) according to the National Cardiovascular Data Registry (NCDR) CathPCI risk score, and its association with clinical outcomes. Using a prospective multicenter Japanese registry, 2968 patients with NSTE-ACS undergoing percutaneous coronary intervention within 72 hours of hospital arrival were analyzed. Multivariable logistic regression analyses were performed to determine predictors of EIS utilization. Additionally, adverse outcomes were compared between patients treated with and without EIS. Overall, 82.1% of the cohort (n = 2436) were treated with EIS, and the median NCDR CathPCI risk score was 22 (interquartile range: 14–32) with an expected 0.3–0.6% in-hospital mortality. Advanced age, peripheral artery disease, chronic kidney disease or patients without elevation of cardiac biomarkers were less likely to be treated with EIS. EIS utilization was not associated with a risk of in-hospital mortality; yet, it was associated with an increased risk of acute kidney injury (AKI) (adjusted odds ratio: 1.42; 95% confidence interval: 1.02–2.01) regardless of patients’ in-hospital mortality risk. Broader use of EIS utilization comes at the cost of increased AKI development risk; thus, the pre-procedural risk-benefit profile of EIS should be reassessed appropriately in patients with lower mortality risk.

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