Validation study of grace risk score for prognosis in Indian patients with non-STEMI
DOI:
https://doi.org/10.18203/2349-3933.ijam20173227Keywords:
Non-ST elevated myocardial infarction, GRACE (Global Registry of Acute Coronary Syndrome)Abstract
Background: Cardiovascular disease has emerged as the single most important cause of death worldwide. Every patient of MI has to be stratified according to the risk factors, so that high risk patients can be identified and can be managed effectively GRACE risk score is one of the score used to calculate the risk in MI. Present study was undertaken to correlate GRACE risk score and mortality in non-STEMI.
Methods: 200 patients of non-STEMI fulfilling the inclusion criteria admitted in wards of NMCH, Kota were recruited. GRACE risk score was calculated for all patients. Each patient monitored closely throughout their hospitalization. Each component of GRACE risk score was studied for statistical significance. Statistical analysis of correlation was done with chi square test and statistical significance was taken p < 0.05.
Results: Mean age is 59.45±8.66 years, with male preponderance, male to female ratio 3:1. Maximum GRACE score is 300 and the minimum score is 86. Patients were categorized into low (74 patients), intermediate (60 patients), high risk (66 patients) according to GRACE score. 14 patients were expired and all of them are in high risk category. GRACE score had sensitivity (100%), specificity (72.04%), positive predictive value (21.2%) and negative predictive value (100%). Serum creatinine (p<0.001), heart rate (p<0.001), blood pressure (p<0.001), Killip class (p<0.001), cardiac biomarkers (p<0.001), ST segment changes (p<0.001) were significantly associated with adverse events. Age>50 (p<0.110) is not significant. Overall grace score demonstrated excellent discrimination (p<0.001), C statistics 0.99, 95% CI 115.742-151.221 for in hospital mortality.
Conclusions: This study has shown GRACE risk score is highly accurate in predicting in hospital mortality in patients of non-STEMI. We should routinely use GRACE risk score in our hospital settings to identify the high-risk patients to decrease mortality.
References
Braunwald’s heart disease: a textbook of cardiovascular medicine, 10th Edition Chapter Global burden of cardiovascular disease: chapter1; 2015:8.
Robert P, Giugliano, Christopher P, Cannon and Eugene Braunwald. Braunwald’s Heart disease Chapter 53. non-ST Elevation Acute Coronary Syndromes; 2004:1160.
de Araújo Gonçalves P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE‐ACS. Eu heart J. 2005;26(9):865-72.
Bradshaw PJ, Katzenellenbogen JM, Sanfilippo FM, Hobbs MS, Thompson PL, Thompson SC. Validation study of GRACE risk scores in indigenous and non-indigenous patients hospitalized with acute coronary syndrome. BMC cardiovascular disorders. 2015;15(1):151.
NICE guidance. Unstable angina and NSTEMI:early management: NICE guidelines:[CG94] 1.2. Assessment of a patient’s risk of future adverse cardiovascular events; 2010.
Tang EW, Med M, Wong C, Herbison P. Global registry of acute coronary Am Heart J. 2006;10:004.
Janus ED, Postiglione A, Singh RB. The modernization of Asia: implications for coronary heart disease. Circulation. 1996;94:2671-3.
McKiegue PM, Ferrie JE, Pierpoint T. Association of early-onset coronary heart disease in south Asians men with glucose intolerance and hyperinsulinemia. Circulation. 1993;87:152-61.
Al Suwaidi J, Reddan DN, Williams K. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002;106:974-80.
Krumholz HM, Chen J, Wang Y. Comparing AMI mortality among hospitals in patients 65 years of age or older: evaluating methods of risk adjustment. Circulation. 1999;99:2986-92.
Bhatt DL, Roe MT, Peterson ED. Utilization of early invasive management strategies for high risk patients with non-ST elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004;292:2096-104.
