Document Detail

Treatment and Outcomes of Patients With Suspected Acute Coronary Syndromes in Relation to Initial Diagnostic Impressions (Insights from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE]).
MedLine Citation:
PMID:  23122889     Owner:  NLM     Status:  Publisher    
The early diagnosis of acute coronary syndrome (ACS) remains challenging, and a considerable proportion of patients are diagnosed with "possible" ACS on admission. The Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 16,618 Canadian patients with suspected ACS in 1999 to 2008. We compared the demographic and clinical characteristics, use of cardiac procedures, prognostic accuracy of the GRACE risk score, and in-hospital outcomes between patients given an admission diagnosis of "definite" versus "possible" ACS by the treating physician. Overall, 11,152 and 5,466 patients were given an initial diagnosis of "definite" ACS and "possible" ACS, respectively. Patients with a "possible" ACS had higher GRACE risk score (median 130 vs 125) and less frequently received aspirin, clopidogrel, heparin, or β blockers within the first 24 hours of presentation and assessment of left ventricular function, stress testing, cardiac catheterization, and percutaneous coronary intervention (all p <0.05). Patients with "possible" ACS had greater rates of in-hospital myocardial infarction (9.0% vs 2.0%, p <0.05) and heart failure (12% vs 8.9%, p <0.05). The GRACE risk score demonstrated excellent discrimination for in-hospital mortality in both groups and for the entire study population. In conclusion, compared to patients with "definite" ACS on presentation, those with "possible" ACS had higher baseline GRACE risk scores but less frequently received evidence-based medical therapies within 24 hours of admission or underwent cardiac procedures during hospitalization. The GRACE risk score provided accurate risk assessment, regardless of the initial diagnostic impression.
Ravi R Bajaj; Shaun G Goodman; Raymond T Yan; Alan J Bagnall; Gabor Gyenes; Robert C Welsh; Kim A Eagle; David Brieger; Krishnan Ramanathan; Francois R Grondin; Andrew T Yan;
Related Documents :
6846119 - Myocardial infarct extension: prevalence, clinical significance, and problems in diagno...
24187769 - An atypical evolution of tako-tsubo cardiomyopathy.
23582629 - Management and outcomes of non-st elevation acute coronary syndromes in relation to pre...
3320259 - Estimation of myocardial infarct size by electrocardiographic and radionuclide techniques.
7557489 - Mi survivors: using drug therapies to protect the heart.
2140009 - Neuroendocrine activation after acute myocardial infarction.
21515029 - Risk for atrial fibrillation in patients with hypertrophic cardiomyopathy: association ...
19719489 - Simple method to eliminate interference between ventricular assist devices and cardiac ...
11467239 - Serum lipoprotein (a) in offspring of patients with premature myocardial infarction.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-1
Journal Detail:
Title:  The American journal of cardiology     Volume:  -     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Medicine, Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Overall perceived health predicts risk of hospitalizations and death in adults with heart failure: a...
Next Document:  Cortisol secretion in depressed, and at-risk adults.