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Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE).

Publication ,  Journal Article
Fox, KAA; Dabbous, OH; Goldberg, RJ; Pieper, KS; Eagle, KA; Van de Werf, F; Avezum, A; Goodman, SG; Flather, MD; Anderson, FA; Granger, CB
Published in: BMJ
November 25, 2006

OBJECTIVE: To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infarction to facilitate triage and management of patients with acute coronary syndrome. DESIGN: Prospective multinational observational study in which we used multivariable regression to develop a final predictive model, with prospective and external validation. SETTING: Ninety four hospitals in 14 countries in Europe, North and South America, Australia, and New Zealand. POPULATION: 43,810 patients (21,688 in derivation set; 22,122 in validation set) presenting with acute coronary syndrome with or without ST segment elevation enrolled in the global registry of acute coronary events (GRACE) study between April 1999 and September 2005. MAIN OUTCOME MEASURES: Death and myocardial infarction. RESULTS: 1989 patients died in hospital, 1466 died between discharge and six month follow-up, and 2793 sustained a new non-fatal myocardial infarction. Nine factors independently predicted death and the combined end point of death or myocardial infarction in the period from admission to six months after discharge: age, development (or history) of heart failure, peripheral vascular disease, systolic blood pressure, Killip class, initial serum creatinine concentration, elevated initial cardiac markers, cardiac arrest on admission, and ST segment deviation. The simplified model was robust, with prospectively validated C-statistics of 0.81 for predicting death and 0.73 for death or myocardial infarction from admission to six months after discharge. The external applicability of the model was validated in the dataset from GUSTO IIb (global use of strategies to open occluded coronary arteries). CONCLUSIONS: This risk prediction tool uses readily identifiable variables to provide robust prediction of the cumulative six month risk of death or myocardial infarction. It is a rapid and widely applicable method for assessing cardiovascular risk to complement clinical assessment and can guide patient triage and management across the spectrum of patients with acute coronary syndrome.

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Published In

BMJ

DOI

EISSN

1756-1833

Publication Date

November 25, 2006

Volume

333

Issue

7578

Start / End Page

1091

Location

England

Related Subject Headings

  • Triage
  • Syndrome
  • Severity of Illness Index
  • Prognosis
  • Myocardial Ischemia
  • Myocardial Infarction
  • Male
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Fox, K. A. A., Dabbous, O. H., Goldberg, R. J., Pieper, K. S., Eagle, K. A., Van de Werf, F., … Granger, C. B. (2006). Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ, 333(7578), 1091. https://doi.org/10.1136/bmj.38985.646481.55
Fox, Keith A. A., Omar H. Dabbous, Robert J. Goldberg, Karen S. Pieper, Kim A. Eagle, Frans Van de Werf, Alvaro Avezum, et al. “Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE).BMJ 333, no. 7578 (November 25, 2006): 1091. https://doi.org/10.1136/bmj.38985.646481.55.
Fox, Keith A. A., et al. “Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE).BMJ, vol. 333, no. 7578, Nov. 2006, p. 1091. Pubmed, doi:10.1136/bmj.38985.646481.55.
Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A, Goodman SG, Flather MD, Anderson FA, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006 Nov 25;333(7578):1091.

Published In

BMJ

DOI

EISSN

1756-1833

Publication Date

November 25, 2006

Volume

333

Issue

7578

Start / End Page

1091

Location

England

Related Subject Headings

  • Triage
  • Syndrome
  • Severity of Illness Index
  • Prognosis
  • Myocardial Ischemia
  • Myocardial Infarction
  • Male
  • Humans
  • General & Internal Medicine
  • Female