OBJECTIVE: To identify patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) with a low likelihood of any adverse in-hospital event. DESIGN, SETTING AND PATIENTS: Data were analysed from 24 097 patients with NSTEMI or unstable angina included in the Global Registry of Acute Coronary Events (January 2001 to September 2007). MAIN OUTCOME MEASURES: In-hospital events were myocardial infarction, arrhythmia, congestive heart failure or shock, major bleeding, stroke or death. Two-thirds of the patients were randomly chosen for model development and the remainder for model validation. Multiple logistic regression identified predictors of freedom from an in-hospital event, and a Freedom-from-Event score was developed. RESULTS: Of the 16 127 patients in the model development group, 19.1% experienced an in-hospital adverse event. Fifteen factors independently predicted freedom from an adverse event: younger age; lower Killip class; unstable angina presentation; no hypotension; no ST deviation; no cardiac arrest at presentation; normal creatinine; decreased pulse rate; no hospital transfer; no history of diabetes, heart failure, peripheral arterial disease, or atrial fibrillation; prehospital use of statins, and no chronic warfarin. In the validation group, 18.6% experienced an adverse event. The model discriminated well between patients experiencing an in-hospital event and those who did not in both derivation and validation groups (c-statistic = 0.77 in both). Patients in the three lowest risk deciles had a very low in-hospital mortality (<0.5%) and an uncomplicated clinical course (>93% event-free in hospital). The model also predicted freedom from postdischarge events (death, myocardial infarction, stroke; c-statistic = 0.77). CONCLUSIONS: The GRACE Freedom-from-Event score can predict the in-hospital course of NSTE-ACS, and identifies up to 30% of the admitted population at low risk of death or any adverse in-hospital event.
OBJECTIVE: To identify patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) with a low likelihood of any adverse in-hospital event. DESIGN, SETTING AND PATIENTS: Data were analysed from 24 097 patients with NSTEMI or unstable angina included in the Global Registry of Acute Coronary Events (January 2001 to September 2007). MAIN OUTCOME MEASURES: In-hospital events were myocardial infarction, arrhythmia, congestive heart failure or shock, major bleeding, stroke or death. Two-thirds of the patients were randomly chosen for model development and the remainder for model validation. Multiple logistic regression identified predictors of freedom from an in-hospital event, and a Freedom-from-Event score was developed. RESULTS: Of the 16 127 patients in the model development group, 19.1% experienced an in-hospital adverse event. Fifteen factors independently predicted freedom from an adverse event: younger age; lower Killip class; unstable angina presentation; no hypotension; no ST deviation; no cardiac arrest at presentation; normal creatinine; decreased pulse rate; no hospital transfer; no history of diabetes, heart failure, peripheral arterial disease, or atrial fibrillation; prehospital use of statins, and no chronic warfarin. In the validation group, 18.6% experienced an adverse event. The model discriminated well between patients experiencing an in-hospital event and those who did not in both derivation and validation groups (c-statistic = 0.77 in both). Patients in the three lowest risk deciles had a very low in-hospital mortality (<0.5%) and an uncomplicated clinical course (>93% event-free in hospital). The model also predicted freedom from postdischarge events (death, myocardial infarction, stroke; c-statistic = 0.77). CONCLUSIONS: The GRACE Freedom-from-Event score can predict the in-hospital course of NSTE-ACS, and identifies up to 30% of the admitted population at low risk of death or any adverse in-hospital event.
Authors: J Dankiewicz; N Nielsen; M Annborn; T Cronberg; D Erlinge; Y Gasche; C Hassager; J Kjaergaard; T Pellis; H Friberg Journal: Intensive Care Med Date: 2015-03-24 Impact factor: 17.440
Authors: Jessica K Zègre Hemsey; Kathleen Dracup; Kirsten E Fleischmann; Claire E Sommargren; Steven M Paul; Barbara J Drew Journal: J Emerg Med Date: 2013-01-26 Impact factor: 1.484
Authors: Alvaro Alonso; Joel M Gore; Hamza H Awad; Ann L Quill; Gilles Montalescot; Frans van de Werf; Dietrich C Gulba; Keith A A Fox; Kim A Eagle; Christopher B Granger; Allison Wyman; Ph Gabriel Steg Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09
Authors: Rachel E J Roach; Frans M Helmerhorst; Willem M Lijfering; Theo Stijnen; Ale Algra; Olaf M Dekkers Journal: Cochrane Database Syst Rev Date: 2015-08-27