Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events
Identifieur interne : 002517 ( Istex/Corpus ); précédent : 002516; suivant : 002518Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events
Auteurs : D. Brieger ; K A A. Fox ; G. Fitzgerald ; K A Eagle ; A. Budaj ; Á Avezum ; C B Granger ; B. Costa ; F A Anderson ; Ph G. StegSource :
- Heart [ 1355-6037 ] ; 2009-06.
English descriptors
- KwdEn :
- Additional factors, Adverse event, Adverse events, American college, Angina, Arrhythmia, Astra zeneca, Atrial, Atrial fibrillation, Baseline characteristics, Boehringer ingelheim, Cardiac, Cardiac arrest, Cardiol, Chest pain, Chronic warfarin, Cohort, Congestive, Congestive heart failure, Coronary artery disease, Coronary care unit, Coronary syndromes, Coronary syndromes table, Decile, Electrocardiographic findings, Elevation, European society, Fibrillation, Global registry, Grace investigators, Grace risk score, Grace risk score9, Grace score, Heart failure, High risk, Highest score, Hospital mortality, Hospital transfer, Infarction, Ischaemic, Ischaemic event, Ischaemic events, Killip class, Medical history, Model development, Myocardial, Myocardial infarction, Nstemi, Observational study, Outcomes research, Particular value, Persistent elevation, Predictive power, Predictor, Presentation characteristics, Regression analysis, Renal dysfunction, Risk prediction, Risk score, Score card, Statin, Syndrome, Syndromes table, Systolic blood pressure, Timi risk score, Total costs, Transient ischaemic attack, Unstable angina, Validation, Validation group, Ventricular, Ventricular fibrillation, Ventricular tachycardia, Warfarin.
- Teeft :
- Additional factors, Adverse event, Adverse events, American college, Angina, Arrhythmia, Astra zeneca, Atrial, Atrial fibrillation, Baseline characteristics, Boehringer ingelheim, Cardiac, Cardiac arrest, Cardiol, Chest pain, Chronic warfarin, Cohort, Congestive, Congestive heart failure, Coronary artery disease, Coronary care unit, Coronary syndromes, Coronary syndromes table, Decile, Electrocardiographic findings, Elevation, European society, Fibrillation, Global registry, Grace investigators, Grace risk score, Grace risk score9, Grace score, Heart failure, High risk, Highest score, Hospital mortality, Hospital transfer, Infarction, Ischaemic, Ischaemic event, Ischaemic events, Killip class, Medical history, Model development, Myocardial, Myocardial infarction, Nstemi, Observational study, Outcomes research, Particular value, Persistent elevation, Predictive power, Predictor, Presentation characteristics, Regression analysis, Renal dysfunction, Risk prediction, Risk score, Score card, Statin, Syndrome, Syndromes table, Systolic blood pressure, Timi risk score, Total costs, Transient ischaemic attack, Unstable angina, Validation, Validation group, Ventricular, Ventricular fibrillation, Ventricular tachycardia, Warfarin.
Abstract
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.
Url:
DOI: 10.1136/hrt.2008.153387
Links to Exploration step
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<front><div type="abstract">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.</div>
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<abstract>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.</abstract>
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<abstract><p>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.</p>
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<title-group><article-title>Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events</article-title>
<alt-title alt-title-type="running-head">Acute coronary syndromes</alt-title>
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<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Brieger</surname>
<given-names>D</given-names>
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<xref ref-type="aff" rid="aff1">1</xref>
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<contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Fox</surname>
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<xref ref-type="aff" rid="aff2">2</xref>
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<given-names>G</given-names>
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<xref ref-type="aff" rid="aff3">3</xref>
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<given-names>Á</given-names>
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<xref ref-type="aff" rid="aff6">6</xref>
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<aff id="aff1"><label>1</label>
<addr-line>Coronary Care Unit, Concord Hospital, Concord, Australia</addr-line>
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<aff id="aff2"><label>2</label>
<addr-line>Cardiovascular Research, Division of Medical & Radiological Sciences, The University of Edinburgh, Edinburgh, UK</addr-line>
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<aff id="aff3"><label>3</label>
<addr-line>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA</addr-line>
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<aff id="aff4"><label>4</label>
<addr-line>University of Michigan Health System, Ann Arbor, Michigan, USA</addr-line>
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<aff id="aff5"><label>5</label>
<addr-line>Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland</addr-line>
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<aff id="aff6"><label>6</label>
<addr-line>Dante Pazzanese Institute of Cardiology, São Paulo, Brazil</addr-line>
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<addr-line>Duke University Medical Center, Durham, North Carolina, USA</addr-line>
</aff>
<aff id="aff8"><label>8</label>
<addr-line>Département de Cardiologie, INSERM U-698, Université Paris 7, AP-HP, Paris, France</addr-line>
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<author-notes><corresp>Dr D Brieger, Concord Repatriation General Hospital, Coronary Care Unit, Level 3, Multi Building, Hospital Road, Concord, NSW Australia 2139; <email xlink:type="simple">davidb@email.cs.nsw.gov.au</email>
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<abstract><sec><title>Objective:</title>
<p>To identify patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) with a low likelihood of any adverse in-hospital event.</p>
</sec>
<sec><title>Design, setting and patients:</title>
<p>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).</p>
</sec>
<sec><title>Main outcome measures:</title>
<p>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.</p>
</sec>
<sec><title>Results:</title>
<p>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).</p>
</sec>
<sec><title>Conclusions:</title>
<p>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.</p>
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<partName>Acute coronary syndromes</partName>
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<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events</title>
<partName>Acute coronary syndromes</partName>
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<name type="corporate"><namePart>for the GRACE Investigators</namePart>
<affiliation>Dr D Brieger, Concord Repatriation General Hospital, Coronary Care Unit, Level 3, Multi Building, Hospital Road, Concord, NSW Australia 2139; davidb@email.cs.nsw.gov.au</affiliation>
</name>
<name type="personal"><namePart type="given">D</namePart>
<namePart type="family">Brieger</namePart>
<affiliation>Coronary Care Unit, Concord Hospital, Concord, Australia</affiliation>
<role><roleTerm type="text">author</roleTerm>
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</name>
<name type="personal"><namePart type="given">K A A</namePart>
<namePart type="family">Fox</namePart>
<affiliation>Cardiovascular Research, Division of Medical & Radiological Sciences, The University of Edinburgh, Edinburgh, UK</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">G</namePart>
<namePart type="family">FitzGerald</namePart>
<affiliation>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">K A</namePart>
<namePart type="family">Eagle</namePart>
<affiliation>University of Michigan Health System, Ann Arbor, Michigan, USA</affiliation>
<role><roleTerm type="text">author</roleTerm>
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</name>
<name type="personal"><namePart type="given">A</namePart>
<namePart type="family">Budaj</namePart>
<affiliation>Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland</affiliation>
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<name type="personal"><namePart type="given">Á</namePart>
<namePart type="family">Avezum</namePart>
<affiliation>Dante Pazzanese Institute of Cardiology, São Paulo, Brazil</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">C B</namePart>
<namePart type="family">Granger</namePart>
<affiliation>Duke University Medical Center, Durham, North Carolina, USA</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">B</namePart>
<namePart type="family">Costa</namePart>
<affiliation>Coronary Care Unit, Concord Hospital, Concord, Australia</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">F A</namePart>
<namePart type="family">Anderson</namePart>
<namePart type="termsOfAddress">Jr</namePart>
<affiliation>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Ph G</namePart>
<namePart type="family">Steg</namePart>
<affiliation>Département de Cardiologie, INSERM U-698, Université Paris 7, AP-HP, Paris, France</affiliation>
<role><roleTerm type="text">author</roleTerm>
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<typeOfResource>text</typeOfResource>
<genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre>
<originInfo><publisher>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher>
<dateIssued encoding="w3cdtf">2009-06</dateIssued>
<dateCreated encoding="w3cdtf">2009-02-25</dateCreated>
<copyrightDate encoding="w3cdtf">2009</copyrightDate>
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<abstract>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.</abstract>
<relatedItem type="host"><titleInfo><title>Heart</title>
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<subject><genre>hwp-journal-coll</genre>
<topic>Acute coronary syndromes</topic>
</subject>
<subject><genre>hwp-journal-coll</genre>
<topic>Drugs: cardiovascular system</topic>
</subject>
<subject><genre>hwp-journal-coll</genre>
<topic>Heart failure</topic>
</subject>
<subject><genre>hwp-journal-coll</genre>
<topic>Acute coronary syndromes</topic>
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<topic>Diabetes</topic>
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<identifier type="ISSN">1355-6037</identifier>
<identifier type="eISSN">1468-201X</identifier>
<identifier type="PublisherID">hrt</identifier>
<identifier type="PublisherID-hwp">heartjnl</identifier>
<identifier type="PublisherID-nlm-ta">Heart</identifier>
<part><date>2009</date>
<detail type="volume"><caption>vol.</caption>
<number>95</number>
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<detail type="issue"><caption>no.</caption>
<number>11</number>
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<extent unit="pages"><start>888</start>
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<identifier type="ark">ark:/67375/NVC-JM8GR853-6</identifier>
<identifier type="DOI">10.1136/hrt.2008.153387</identifier>
<identifier type="href">heartjnl-95-888.pdf</identifier>
<identifier type="ArticleID">ht153387</identifier>
<identifier type="PMID">19246481</identifier>
<identifier type="local">heartjnl;95/11/888</identifier>
<accessCondition type="use and reproduction" contentType="copyright">2009 BMJ Publishing Group and British Cardiac Society</accessCondition>
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