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Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.

Publication ,  Journal Article
Brieger, D; Fox, KAA; Fitzgerald, G; Eagle, KA; Budaj, A; Avezum, A; Granger, CB; Costa, B; Anderson, FA; Steg, PG ...
Published in: Heart
June 2009

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.

Duke Scholars

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2009

Volume

95

Issue

11

Start / End Page

888 / 894

Location

England

Related Subject Headings

  • Prognosis
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Epidemiologic Methods
  • Electrocardiography
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brieger, D., Fox, K. A. A., Fitzgerald, G., Eagle, K. A., Budaj, A., Avezum, A., … Global Registry of Acute Coronary Events Investigators, . (2009). Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart, 95(11), 888–894. https://doi.org/10.1136/hrt.2008.153387
Brieger, D., K. A. A. Fox, G. Fitzgerald, K. A. Eagle, A. Budaj, A. Avezum, C. B. Granger, et al. “Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.Heart 95, no. 11 (June 2009): 888–94. https://doi.org/10.1136/hrt.2008.153387.
Brieger D, Fox KAA, Fitzgerald G, Eagle KA, Budaj A, Avezum A, et al. Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009 Jun;95(11):888–94.
Brieger, D., et al. “Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.Heart, vol. 95, no. 11, June 2009, pp. 888–94. Pubmed, doi:10.1136/hrt.2008.153387.
Brieger D, Fox KAA, Fitzgerald G, Eagle KA, Budaj A, Avezum A, Granger CB, Costa B, Anderson FA, Steg PG, Global Registry of Acute Coronary Events Investigators. Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009 Jun;95(11):888–894.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2009

Volume

95

Issue

11

Start / End Page

888 / 894

Location

England

Related Subject Headings

  • Prognosis
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Epidemiologic Methods
  • Electrocardiography