Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events
Authors
Brieger, DavidFox, Keith A. A.
Fitzgerald, Gordon
Eagle, Kim A.
Budaj, Andrzej
Avezum, Alvaro
Granger, Christopher B.
Costa, B.
Anderson, Frederick A. Jr.
Steg, Phillippe Gabriel
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2009-06-28Keywords
Acute Coronary SyndromeAdult
Age Factors
Aged
Aged, 80 and over
Arrhythmias, Cardiac
Electrocardiography
Epidemiologic Methods
Female
Heart Failure
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction
Prognosis
Health Services Research
Metadata
Show full item recordAbstract
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.Source
Heart. 2009 Jun;95(11):888-94. Epub 2009 Feb 25. Link to article on publisher's siteDOI
10.1136/hrt.2008.153387Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27199PubMed ID
19246481Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1136/hrt.2008.153387