Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)
Identifieur interne : 000F86 ( Pmc/Corpus ); précédent : 000F85; suivant : 000F87Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)
Auteurs : K A A. Fox ; F A Anderson ; O H Dabbous ; P G Steg ; J. L Pez-Send N ; F. Van De Werf ; A. Budaj ; E P Gurfinkel ; S G Goodman ; D. BriegerSource :
- Heart [ 1355-6037 ] ; 2006.
Abstract
To determine whether revascularisation is more likely to be performed in higher‐risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies.
GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24 189 patients enrolled at 73 hospitals with on‐site angiographic facilities.
Overall, 32.5% of patients with a non‐ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in‐hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low‐risk to 3.3% in medium‐risk and 13.0% in high‐risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low‐ (40% non‐STEMI, 60% STEMI) than medium‐ (35%, 54%) or high‐risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non‐ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2−33.7%, n = 7210 observations), medium (35.7−51.4%, n = 7913 observations) or high rates (52.6−77.0%, n = 8942 observations) of intervention.
A risk‐averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient's risk status. Systematic and accurate risk stratification may allow higher‐risk patients to be selected for revascularisation procedures, in contrast to current international practice.
Url:
DOI: 10.1136/hrt.2005.084830
PubMed: 16757543
PubMed Central: 1861403
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PMC:1861403Le document en format XML
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L Pez-Send N</name></author><author><name sortKey="Van De Werf, F" sort="Van De Werf, F" uniqKey="Van De Werf F" first="F" last="Van De Werf">F. Van De Werf</name></author><author><name sortKey="Budaj, A" sort="Budaj, A" uniqKey="Budaj A" first="A" last="Budaj">A. Budaj</name></author><author><name sortKey="Gurfinkel, E P" sort="Gurfinkel, E P" uniqKey="Gurfinkel E" first="E P" last="Gurfinkel">E P Gurfinkel</name></author><author><name sortKey="Goodman, S G" sort="Goodman, S G" uniqKey="Goodman S" first="S G" last="Goodman">S G Goodman</name></author><author><name sortKey="Brieger, D" sort="Brieger, D" uniqKey="Brieger D" first="D" last="Brieger">D. Brieger</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">16757543</idno><idno type="pmc">1861403</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861403</idno><idno type="RBID">PMC:1861403</idno><idno type="doi">10.1136/hrt.2005.084830</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">000F86</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F86</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)</title><author><name sortKey="Fox, K A A" sort="Fox, K A A" uniqKey="Fox K" first="K A A" last="Fox">K A A. Fox</name></author><author><name sortKey="Anderson, F A" sort="Anderson, F A" uniqKey="Anderson F" first="F A" last="Anderson">F A Anderson</name></author><author><name sortKey="Dabbous, O H" sort="Dabbous, O H" uniqKey="Dabbous O" first="O H" last="Dabbous">O H Dabbous</name></author><author><name sortKey="Steg, P G" sort="Steg, P G" uniqKey="Steg P" first="P G" last="Steg">P G Steg</name></author><author><name sortKey="L Pez End N, J" sort="L Pez End N, J" uniqKey="L Pez End N J" first="J" last="L Pez-Send N">J. L Pez-Send N</name></author><author><name sortKey="Van De Werf, F" sort="Van De Werf, F" uniqKey="Van De Werf F" first="F" last="Van De Werf">F. Van De Werf</name></author><author><name sortKey="Budaj, A" sort="Budaj, A" uniqKey="Budaj A" first="A" last="Budaj">A. Budaj</name></author><author><name sortKey="Gurfinkel, E P" sort="Gurfinkel, E P" uniqKey="Gurfinkel E" first="E P" last="Gurfinkel">E P Gurfinkel</name></author><author><name sortKey="Goodman, S G" sort="Goodman, S G" uniqKey="Goodman S" first="S G" last="Goodman">S G Goodman</name></author><author><name sortKey="Brieger, D" sort="Brieger, D" uniqKey="Brieger D" first="D" last="Brieger">D. Brieger</name></author></analytic><series><title level="j">Heart</title><idno type="ISSN">1355-6037</idno><idno type="eISSN">1468-201X</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To determine whether revascularisation is more likely to be performed in higher‐risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies.</p></sec><sec><title>Methods</title><p>GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24 189 patients enrolled at 73 hospitals with on‐site angiographic facilities.</p></sec><sec><title>Results</title><p>Overall, 32.5% of patients with a non‐ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in‐hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low‐risk to 3.3% in medium‐risk and 13.0% in high‐risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low‐ (40% non‐STEMI, 60% STEMI) than medium‐ (35%, 54%) or high‐risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non‐ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2−33.7%, n = 7210 observations), medium (35.7−51.4%, n = 7913 observations) or high rates (52.6−77.0%, n = 8942 observations) of intervention.</p></sec><sec><title>Conclusions</title><p>A risk‐averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient's risk status. Systematic and accurate risk stratification may allow higher‐risk patients to be selected for revascularisation procedures, in contrast to current international practice.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Heart</journal-id><journal-title>Heart</journal-title><issn pub-type="ppub">1355-6037</issn><issn pub-type="epub">1468-201X</issn><publisher><publisher-name>BMJ Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">16757543</article-id><article-id pub-id-type="pmc">1861403</article-id><article-id pub-id-type="publisher-id">ht84830</article-id><article-id pub-id-type="doi">10.1136/hrt.2005.084830</article-id><article-categories><subj-group subj-group-type="heading"><subject>Acute Coronary Syndromes</subject></subj-group></article-categories><title-group><article-title>Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fox</surname><given-names>K A A</given-names></name></contrib><contrib contrib-type="author"><name><surname>Anderson</surname><given-names>F A</given-names><suffix>Jr</suffix></name></contrib><contrib contrib-type="author"><name><surname>Dabbous</surname><given-names>O H</given-names></name></contrib><contrib contrib-type="author"><name><surname>Steg</surname><given-names>P G</given-names></name></contrib><contrib contrib-type="author"><name><surname>López‐Sendón</surname><given-names>J</given-names></name></contrib><contrib contrib-type="author"><name><surname>Van de Werf</surname><given-names>F</given-names></name></contrib><contrib contrib-type="author"><name><surname>Budaj</surname><given-names>A</given-names></name></contrib><contrib contrib-type="author"><name><surname>Gurfinkel</surname><given-names>E P</given-names></name></contrib><contrib contrib-type="author"><name><surname>Goodman</surname><given-names>S G</given-names></name></contrib><contrib contrib-type="author"><name><surname>Brieger</surname><given-names>D</given-names></name></contrib><on-behalf-of>on behalf of the GRACE investigators</on-behalf-of></contrib-group><aff><bold>K A A Fox</bold>, Cardiovascular Research, Division of Medical & Radiological Sciences, The University of Edinburgh, Edinburgh, UK</aff><aff><bold>F A Anderson</bold>,<bold>O H Dabbous</bold>, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA</aff><aff><bold>P G Steg</bold>, Cardiology, Hôpital Bichat, Paris, France</aff><aff><bold>J López‐Sendón</bold>, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain</aff><aff><bold>F Van de Werf</bold>, Department of Cardiology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium</aff><aff><bold>A Budaj</bold>, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland</aff><aff><bold>E P Gurfinkel</bold>, Department of Cardiology, ICYCC Favaloro Foundation, Buenos Aires, Argentina</aff><aff><bold>S G Goodman</bold>, Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</aff><aff><bold>D Brieger</bold>, Coronary Care Unit, Concord Hospital, Sydney, Australia</aff><author-notes><corresp>Correspondence to: Professor Keith A A Fox<break></break>Cardiovascular Research, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; k.a.a.fox@ed.ac.uk</corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>6</day><month>6</month><year>2006</year></pub-date><volume>93</volume><issue>2</issue><fpage>177</fpage><lpage>182</lpage><history><date date-type="accepted"><day>24</day><month>5</month><year>2006</year></date></history><permissions><copyright-statement>Copyright © 2007 BMJ Publishing Group and British Cardiovascular Society
</copyright-statement></permissions><abstract><sec><title>Objective</title><p>To determine whether revascularisation is more likely to be performed in higher‐risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies.</p></sec><sec><title>Methods</title><p>GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24 189 patients enrolled at 73 hospitals with on‐site angiographic facilities.</p></sec><sec><title>Results</title><p>Overall, 32.5% of patients with a non‐ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in‐hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low‐risk to 3.3% in medium‐risk and 13.0% in high‐risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low‐ (40% non‐STEMI, 60% STEMI) than medium‐ (35%, 54%) or high‐risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non‐ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2−33.7%, n = 7210 observations), medium (35.7−51.4%, n = 7913 observations) or high rates (52.6−77.0%, n = 8942 observations) of intervention.</p></sec><sec><title>Conclusions</title><p>A risk‐averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient's risk status. Systematic and accurate risk stratification may allow higher‐risk patients to be selected for revascularisation procedures, in contrast to current international practice.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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