scholarly journals The GRACE Scale in the Prognosis of Patients with Takotsubo Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
Hanna Bachorzewska-Gajewska
Keyword(s):  
Roc Curve ◽  
Sudden Cardiac Arrest ◽  
Takotsubo Syndrome ◽  
Invasive Cardiology ◽  
Area Under Roc Curve ◽  
St Elevation ◽  
The Mean ◽  
Long Term Observation ◽  
Grace Score

Background. The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy. Methods. 101 patients with TTS hospitalized in four centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into two groups: I—52 patients (GRACE ≤ 140 points) and II—49 patients (GRACE > 140 points). Results. The mean GRACE score in the study group was 138.66. The in-hospital stay of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36.7% vs 7.69%, p=0.0004), rhythm abnormalities (17.3% vs 3.85%, p=0.026), and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30.6% vs 5.77%, p=0.001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18.37% vs 3.85%, p=0.019), 1-year (22.45 vs 3.85%, p=0.005), 3-year (40.82 vs 3.85%, p<0.0001), 5-year (42.86% vs 3.85%, p<0.0001), and 7-year mortalities (53.06% vs 9.62%, p<0.0001) was observed in the group of patients with a GRACE score ≥140. At multivariate analysis including low BMI, low eGFR, and a higher GRACE score, all these factors were independent predictor of death (p=0.042; p=0.010; p=0.041). The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognostication. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI: 0.718–0.892, p<0.0001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS. Conclusion. The GRACE scale is highly valuable for the prognostication of death risk in patients with TTS in the early and long-term observation.

scholarly journals The GRACE scale in the prognosis of patients with Takotsubo syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Zalewska-Adamiec ◽  
L Kuzma ◽  
S Dobrzycki ◽  
H Bachorzewska-Gajewska
Keyword(s):  
Roc Curve ◽  
Sudden Cardiac Arrest ◽  
Takotsubo Syndrome ◽  
Death Risk ◽  
Invasive Cardiology ◽  
Area Under Roc Curve ◽  
St Elevation ◽  
The Mean ◽  
Grace Score

Abstract Background The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy. Methods 101 patients with TTS were hospitalized in 4 centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into 2 groups: I – 52 patients (GRACE ≤140 points) and II – 49 patients (GRACE &gt;140 points). Results The mean GRACE score in study group was 138.66. The course of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36,7% vs 7,69%, p=0,0004), rhythm abnormalities (17,3% vs 3,85%, p=0,026) and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30,6% vs 5,77%, p=0,001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18,37% vs 3,85%, p=0,019),1-year (22,45 vs 3,85%, p=0,005), 3-year (40,82 vs 3,85%, p&lt;0,0001), 5-year (42,86% vs 3,85%, p&lt;0,0001) and 7-year mortality (53,06% vs 9,62%, p&lt;0,0001) was observed in the group of patients with a GRACE score ≥140. The death risk factors in the multivariate analysis performed were low BMI, low eGFR, and a higher GRACE score The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognosis. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI - 0.718–0.892, p&lt;0.001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS. Conclusion The GRACE scale is highly valuable for the prognosis of death risk in patients with TTS in the early and follow-up period. Funding Acknowledgement Type of funding source: None

An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Pessoa Amorim ◽  
D Santos-Ferreira ◽  
A Azul Freitas ◽  
H Santos ◽  
A Belo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wald Test ◽  
Invasive Procedures ◽  
Frailty Status ◽  
Frail Patients ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
St Elevation ◽  
Grace Score

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI &gt;25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine &gt;2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (&gt;3 cardiovascular drugs), admission haemoglobin &lt;10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI&gt;0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p&lt;0.001). Delayed angiography (&gt;72h) was more common among NSTEMI frail patients (p&lt;0.001), and radial access was less commonly used overall (p&lt;0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p&lt;0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p&lt;0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p&lt;0.05), their 1-year prognostic benefit remained unaffected (Wald test p&gt;0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p&lt;0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology

scholarly journals Using the GRACE Score to Assess Long-term Risk in Patients with Non-ST Elevation Acute Coronary Syndrome

Doctor Ru ◽  
2019 ◽  
Vol 157 (2) ◽  
pp. 12-18
Author(s):  
S.A. Berns ◽  
◽  
E.A. Shmidt ◽  
A.V. Klimenkova ◽  
S.A. Tumanova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Grace Score

scholarly journals Influence of external peer reviewer scores for funding applications on funding board decisions: a retrospective analysis of 1561 reviews

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022547 ◽  
Author(s):  
Lexy Sorrell ◽  
Nicola Mcardle ◽  
Taeko Becque ◽  
Helen Payne ◽  
Beth Stuart ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Roc Curve ◽  
Health Research ◽  
Research Funding ◽  
Roc Curves ◽  
Substantial Improvement ◽  
Area Under Roc Curve ◽  
The Mean ◽  
Applied Health Research ◽  
Better Than

ObjectivesTo evaluate the influence of external peer reviewer scores on the National Institute for Health Research (NIHR) research funding board decisions by the number of reviewers and type of reviewer expertise.DesignRetrospective analysis of external peer review scores for shortlisted full applications for funding (280 funding applications, 1236 individual reviewers, 1561 review scores).SettingFour applied health research funding programmes of NIHR, UK.Main outcome measuresBoard decision to fund or not fund research applications.ResultsThe mean score of reviewers predicted funding decisions better than individual reviewer scores (area under the receiver operating characteristic (ROC) curve 0.75, 95% CI 0.69 to 0.81 compared with 0.62, CI 0.59 to 0.65). There was no substantial improvement in how accurately mean reviewer scores predicted funding decisions when the number of reviewers increased above 4 (area under ROC curve 0.75, CI 0.59 to 0.91 for four reviewers; 0.80, CI 0.67 to 0.92 for seven or more). Reviewers with differing expertise influenced the board’s decision equally, including public and patient reviewers (area under ROC curves from 0.57, CI 0.47 to 0.66 for health economists to 0.64, CI 0.57 to 0.70 for subject-matter experts). The areas under the ROC curves were quite low when using reviewers’ scores, confirming that boards do not rely solely on those scores alone to make their funding decisions, which are best predicted by the mean board score.ConclusionsBoards value scores that originate from a diverse pool of reviewers. On the basis of independent reviewer score alone, there is no detectable benefit of using more than four reviewer scores in terms of their influence on board decisions, so to improve efficiency, it may be possible to avoid using larger numbers of reviewers. The funding decision is best predicted by the board score.

scholarly journals The value of the Global Registry of Acute Coronary Events and Gensini scores in predicting long-term outcomes in Vietnamese patients with non-ST-elevation acute coronary syndrome

2021 ◽  
Vol 8 (2) ◽  
pp. 4233-4240
Author(s):  
Sy Van Hoang ◽  
Kha Minh Nguyen ◽  
An Hoang Nguyen ◽  
Khoa Le Anh Huynh ◽  
Hai Phuong Nguyen Tran
Keyword(s):  
Risk Score ◽  
Gensini Score ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
St Elevation ◽  
Coronary Events ◽  
Artery Disease ◽  
Grace Score

Introduction: Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) should undergo risk stratification as soon as possible after their presentation. Early risk satisfaction provides good prognosis for patients as well as better decision for reperfusion therapy. The aim of this study is to find a correlation between the Global Registry of Acute Coronary Events (GRACE) risk score and severity of coronay artery disease assessed by Gensini score score and compare the value of GRACE and Gensini scores in predicting the long-term outcomes in patients with NSTE-ACS. Methods: A total of 220 patients with NSTE-ACS who underwent coronary angiography were enrolled in our study. The Gensini score was used to assess the severity of coronary artery disease. According to the GRACE score, the patients were grouped into low, intermediate and high groups. After 30 months of follow-up, 20 patients died. Results: The mean Gensini scores were 11.8 ± 11.5, 27.4 ± 30.9, and 42.9 ± 29.7 in the low, intermediate and high-risk groups, respectively. The GRACE scores and Gensini score had a moderate positive correlation (rho = 0.522, p < 0.001). The survival rates showed a less rapid deterioration from the low to high GRACE groups (P = 0.013) than when classified according to their Gensini tertiles (P = 0.02). Area under the ROC curve was statistically significant for both scores, but area of the GRACE risk score (0.71; 95% Cl = 0.60 - 0.82) was higher than that the Gensini risk score (0.66; 95% Cl = 0.53 – 0.80). Conclusion: Our study revealed that the Gensini score had a positive and significant relationship with the GRACE score in patients with NSTE-ACS. The GRACE score had a more value in predicting long-term outcomes in patients with NSTE-ACS.

scholarly journals Clinical Characteristics and Long-Term Mortality Rate in Female Patients with Takotsubo Syndrome Compared with Female Patients with ST-Elevation Acute Myocardial Infarction: A Retrospective Study from a Single Center

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Laura Massobrio ◽  
Alberto Valbusa ◽  
Marina Sartini ◽  
Giovanni Meliota ◽  
Francesca Cavalla ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Female Patients ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
St Elevation

Background. Takotsubo syndrome (TTS) is characterized by acute transient, stress-induced, left ventricular systolic dysfunction, generally presenting with apical ballooning. It can mimic an acute coronary syndrome, but with a milder increase in cardiac enzymes and without culprit coronary artery disease on angiography. Data on long-term follow-up and survival in patients with TTS, compared with patients with ST-elevation myocardial infarction (STEMI), are scarce. Purpose. To assess all-cause mortality rate and survival in a consecutive series of female patients with TTS compared with age- and sex-matched STEMI patients on long-term follow-up. Methods and Results. We collected data of 65 TTS female patients (TTS group) with a mean age of 73.42 ± 11.35 years from 2001 to 2013. Collection of follow-up information was concluded for all patients in 2016. To compare the mortality and survival of TTS patients with those of the STEMI population, we used data from our STEMI Registry, a prospective registry of 7446 STEMI patients admitted from 2001 to 2013 to our cath-lab for primary percutaneous coronary intervention (p-PCI). From the registry, we selected 104 STEMI patients (STEMI group) comparable to our TTS group in terms of age (mean age of 72.33 ± 11.92 years) and sex. On follow-up examination after a median of 1000 days, the TTS group had a lower all-cause mortality rate than the STEMI group (7.69% versus 23.08%). This difference was statistically different between the two groups (log-rank test, p value = 0.03). Conclusions. In our study, TTS and STEMI patients displayed a statistically significant difference in long-term survival. Specifically, the TTS group had a lower mortality rate than the STEMI group. This seems to suggest that TTS and STEMI are two different clinical entities with two different clinical outcomes.

scholarly journals Prognostic relevance of GRACE risk score in Takotsubo syndrome

2019 ◽  
Vol 9 (7) ◽  
pp. 721-728 ◽  
Author(s):  
Fernando Scudiero ◽  
Luca Arcari ◽  
Luca Cacciotti ◽  
Elena De Vito ◽  
Rossella Marcucci ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Grace Score

Background: Takotsubo syndrome is an increasingly recognised cardiac condition that clinically mimics an acute coronary syndrome, but data regarding its prognosis remain controversial. It is currently unknown whether acute coronary syndrome risk scores could effectively be applied to Takotsubo syndrome patients. This study aims to assess whether the Global Registry of Acute Coronary Events (GRACE) score can predict clinical outcome in Takotsubo syndrome and to compare the prognosis with matched acute coronary syndrome patients. Methods: A total of 561 Takotsubo syndrome patients was included in this prospective registry. According to the GRACE score, the population was divided into quartiles. The primary endpoint was all-cause mortality and the secondary endpoints were cardiocerebrovascular events (a composite of all-cause mortality, cardiovascular death, recurrence of Takotsubo syndrome and stroke). Results: The median GRACE risk score was 139±27. Takotsubo syndrome patients with a higher GRACE risk score mostly have a higher rate of physical triggers and lower left ventricular ejection fraction on admission. During long-term follow-up, all-cause mortality rates were 5%, 11%, 12% and 22%, respectively, in the first, second, third and fourth quartile ( P<0.001). After multivariate analysis, the GRACE risk score was found to be a strong predictor of all-cause mortality (odds ratio (OR) 1.68, 95% confidence interval (CI) 1.28–2.20; P=0.001) and cardiocerebrovascular events (OR 1.63, 95% CI 1.26–2.11; P=0.001). Moreover, all-cause mortality in Takotsubo syndrome patients was comparable with the matched acute coronary syndrome cohort. Conclusion: In Takotsubo syndrome, the GRACE risk score allows us to predict all-cause mortality and cardiocerebrovascular events at long-term follow-up.

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