Sami M A Alnasser1, Wei Huang2, Joel M Gore2, Ph Gabriel Steg3, Kim A Eagle4, Frederick A Anderson5, Keith A A Fox6, Enrique Gurfinkel7, David Brieger8, Werner Klein9, Frans van de Werf10, Álvaro Avezum11, Gilles Montalescot12, Dietrich C Gulba13, Andrzej Budaj14, Jose Lopez-Sendon15, Christopher B Granger16, Brian M Kennelly17, Robert J Goldberg18, Emily Fleming19, Shaun G Goodman20. 1. Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia. 2. Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester. 3. INSERM U-698, Université Paris 7, Centre Hospitalier Bichat-Claude Bernard, Paris, France. 4. University of Michigan Health System, Ann Arbor. 5. Center for Outcomes Research, University of Massachusetts Medical School, Worcester. 6. Centre for Cardiovascular Science, University of Edinburgh, United Kingdom. 7. ICYCC Favaloro Foundation, Buenos Aires, Argentina. 8. Concord Hospital and University of Sydney, Sydney, Australia. 9. Department of Internal Medicine, Krankenhaus der Barmherzigen Bruder, Teaching Hospital of the Karl Franzens University Graz, Graz, Austria. 10. Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium. 11. Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil. 12. Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (AP-HP), Univ Paris 06, Paris, France. 13. Department of Cardiology, KKO St. Marien-Hospital, Oberhausen, Germany. 14. Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland. 15. Hospital Universitario La Paz, Instituto de Investigación La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain. 16. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 17. Hoag Memorial Hospital Presbyterian, Newport Beach, Calif. 18. Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. 19. Canadian Heart Research Centre, Toronto, Ont., Canada. 20. Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; Canadian Heart Research Centre, Toronto, Ont., Canada. Electronic address: goodmans@smh.ca.
Abstract
PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality. METHODS: Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites. RESULTS: From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80). CONCLUSION: In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.
PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality. METHODS: Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites. RESULTS: From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80). CONCLUSION: In this large multinational cohort of acute coronary syndromepatients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.
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