Nevertheless, a significant proportion of adverse events in NSTE‐ACS patients occur after the first 30 days, and it is not known whether these RS can also predict their occurrence. All these scores were developed for short-term prognosis: events in-hospital for the GRACE risk score (RS), at 14 days for the TIMI RS, and at 30 days for the PURSUIT RS. The more recent Global Registry of Acute Coronary Events (GRACE) score was developed from the registry, 8 with a population of patients across the entire spectrum of ACS. The thrombolysis In Myocardial Infarction (TIMI) 6 and platelet glycoprotein IIb/IIIa in unstable agina: Receptor Suppression Using Integrilin (PURSUIT) 7 scores were developed with the databases from large clinical trials of NSTE‐ACS. 3– 5 Different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission. 1, 2 In these patients, early risk stratification plays a central role, as the benefit of newer and more aggressive and costly treatment strategies seems to be proportional to the risk of adverse clinical events. Patients with non-ST elevation acute coronary syndromes (NSTE‐ACS) are a heterogeneous population with varying risks of death and recurrent cardiac events, in long-term as well as short-term follow-up. See page 851 for the editorial comment on this article (doi:10.1093/eurheartj/ehi214) Introduction TIMI risk score, PURSUIT risk score, GRACE risk score, Coronary disease, Myocardial infarction, Unstable angina, Prognosis, Risk stratification The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively.Ĭonclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) but the performance of the PURSUIT RS (AUC: 0.630 CI: 0.584–0.674), and TIMI RS (AUC: 0.585 CI: 0.539–0.631) was also good. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |