Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score
Objectives: Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular read...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-06-01
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| Series: | Revista Portuguesa de Cardiologia |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0870255115001250 |
| _version_ | 1818536553852436480 |
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| author | Sergio Raposeiras-Roubín Emad Abu-Assi Cristina Cambeiro-González Belén Álvarez-Álvarez Eva Pereira-López Santiago Gestal-Romaní Milagros Pedreira-López Pedro Rigueiro-Veloso Alejandro Virgós-Lamela José María García-Acuña José Ramón González-Juanatey |
| author_facet | Sergio Raposeiras-Roubín Emad Abu-Assi Cristina Cambeiro-González Belén Álvarez-Álvarez Eva Pereira-López Santiago Gestal-Romaní Milagros Pedreira-López Pedro Rigueiro-Veloso Alejandro Virgós-Lamela José María García-Acuña José Ramón González-Juanatey |
| author_sort | Sergio Raposeiras-Roubín |
| collection | DOAJ |
| description | Objectives: Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. Methods: This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. Results: One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02–1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79±0.02) and optimal fit (Hosmer–Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. Conclusions: The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Resumo: Objetivos: Tendo em conta a importância crescente das taxas de mortalidade e readmissão precoce nos doentes com síndrome coronária aguda (SCA), realizámos este estudo que pretende avaliar a precisão do score de risco GRACE na identificação dos doentes com risco elevado de readmissão e mortalidade cardiovascular no primeiro mês após a alta. Método: Estudo retrospetivo efetuado num único centro com 4229 doentes com SCA com alta entre 2004-2010. Objetivo primário foi a combinação de mortalidade e readmissão por reenfarte, insuficiência cardíaca ou acidente vascular cerebral aos 30 dias após a alta. Resultados: Cento e catorze doentes tiveram eventos aos 30 dias: mortalidade 2,7%; reenfarte 1%; insuficiência cardíaca 1,3%; e acidente vascular cerebral 0,2%. Após uma análise multivariada, o score de risco GRACE aos seis meses esteve associado com um maior risco de eventos aos 30 dias (HR 1,03, IC 95% 1,02-1,04, p<0,001), demonstrando uma boa discriminação (C-statistics: 0,79±0,02) com uma calibração ótima (HL p: 0,83). A sensibilidade e especificidade foram adequadas (78,1-63,3%, respetivamente), com um valor preditivo negativo excelente (99,1%). Numa análise separada de cada um dos eventos em causa (mortalidade por todas as causas, reenfarte, insuficiência cardíaca ou acidente vascular cerebral), a avaliação do score de risco GRACE aos seis meses mostrou também uma boa discriminação e calibração, assim como valores preditivos adequados. Conclusões: O score de risco GRACE aos seis meses é um instrumento útil na predição da morte e das readmissões precoces cardiovasculares aos 30 dias. Os médicos podem recorrer facilmente a este score (app móvel, online) e aplicá-lo na prática clínica diária. Keywords: GRACE risk score, 30-day events, Mortality, Reinfarction, Heart failure, Stroke, Palavras-chave: Score de risco GRACE, Eventos aos 30 dias, Mortalidade, Reenfarte, Insuficiência cardíaca, Acidente vascular cerebral |
| first_indexed | 2024-12-11T18:39:27Z |
| format | Article |
| id | doaj.art-fa89027cdf3146ceada919c195c71821 |
| institution | Directory Open Access Journal |
| issn | 0870-2551 |
| language | English |
| last_indexed | 2024-12-11T18:39:27Z |
| publishDate | 2015-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Revista Portuguesa de Cardiologia |
| spelling | doaj.art-fa89027cdf3146ceada919c195c718212022-12-22T00:54:39ZengElsevierRevista Portuguesa de Cardiologia0870-25512015-06-01346383391Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk scoreSergio Raposeiras-Roubín0Emad Abu-Assi1Cristina Cambeiro-González2Belén Álvarez-Álvarez3Eva Pereira-López4Santiago Gestal-Romaní5Milagros Pedreira-López6Pedro Rigueiro-Veloso7Alejandro Virgós-Lamela8José María García-Acuña9José Ramón González-Juanatey10Corresponding author.; Department of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainDepartment of Cardiology, University Clinical Hospital of Santiago de Compostela, SpainObjectives: Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. Methods: This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. Results: One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02–1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79±0.02) and optimal fit (Hosmer–Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. Conclusions: The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Resumo: Objetivos: Tendo em conta a importância crescente das taxas de mortalidade e readmissão precoce nos doentes com síndrome coronária aguda (SCA), realizámos este estudo que pretende avaliar a precisão do score de risco GRACE na identificação dos doentes com risco elevado de readmissão e mortalidade cardiovascular no primeiro mês após a alta. Método: Estudo retrospetivo efetuado num único centro com 4229 doentes com SCA com alta entre 2004-2010. Objetivo primário foi a combinação de mortalidade e readmissão por reenfarte, insuficiência cardíaca ou acidente vascular cerebral aos 30 dias após a alta. Resultados: Cento e catorze doentes tiveram eventos aos 30 dias: mortalidade 2,7%; reenfarte 1%; insuficiência cardíaca 1,3%; e acidente vascular cerebral 0,2%. Após uma análise multivariada, o score de risco GRACE aos seis meses esteve associado com um maior risco de eventos aos 30 dias (HR 1,03, IC 95% 1,02-1,04, p<0,001), demonstrando uma boa discriminação (C-statistics: 0,79±0,02) com uma calibração ótima (HL p: 0,83). A sensibilidade e especificidade foram adequadas (78,1-63,3%, respetivamente), com um valor preditivo negativo excelente (99,1%). Numa análise separada de cada um dos eventos em causa (mortalidade por todas as causas, reenfarte, insuficiência cardíaca ou acidente vascular cerebral), a avaliação do score de risco GRACE aos seis meses mostrou também uma boa discriminação e calibração, assim como valores preditivos adequados. Conclusões: O score de risco GRACE aos seis meses é um instrumento útil na predição da morte e das readmissões precoces cardiovasculares aos 30 dias. Os médicos podem recorrer facilmente a este score (app móvel, online) e aplicá-lo na prática clínica diária. Keywords: GRACE risk score, 30-day events, Mortality, Reinfarction, Heart failure, Stroke, Palavras-chave: Score de risco GRACE, Eventos aos 30 dias, Mortalidade, Reenfarte, Insuficiência cardíaca, Acidente vascular cerebralhttp://www.sciencedirect.com/science/article/pii/S0870255115001250 |
| spellingShingle | Sergio Raposeiras-Roubín Emad Abu-Assi Cristina Cambeiro-González Belén Álvarez-Álvarez Eva Pereira-López Santiago Gestal-Romaní Milagros Pedreira-López Pedro Rigueiro-Veloso Alejandro Virgós-Lamela José María García-Acuña José Ramón González-Juanatey Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score Revista Portuguesa de Cardiologia |
| title | Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score |
| title_full | Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score |
| title_fullStr | Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score |
| title_full_unstemmed | Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score |
| title_short | Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score |
| title_sort | mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary european cohort of patients how can early risk prediction be improved the six month grace risk score |
| url | http://www.sciencedirect.com/science/article/pii/S0870255115001250 |
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