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.

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<0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p<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<0.0001) and 0.79 (95% CI 0.76–0.81, p<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<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<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 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.

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