Abstract
The Global Registry of Acute Coronary Events (GRACE) registry reported that the in-hospital risk of death from non-ST elevation myocardial infarction (NSTEMI) is 5%, with an 11% mortality by 6 months. Prospective Registry of Acute Ischaemic Syndromes in the UK demonstrated that the overall risk of death from NSTEMI over 4 years is 25%. In GRACE, while 28% of patients received percutaneous intervention, only 10% received coronary artery bypass graft (CABG). Results of urgent CABG surgery following NSTEMI are difficult to interpret as these often include patients who have had STEMIs and urgent surgery. With increasing multidisciplinary assessment of patients with acute coronary syndromes (ACS), accurate data collection on the outcome of such patients could inform correct revascularization strategy. Three hundred and forty-two consecutive patients who had undergone urgent CABG from April 2004 to April 2009 at a single institution were identified. The GRACE predicted mortality was calculated from hospital records and patients categorized into three groups based upon their predicted risk. Late survival data were obtained from the UK Office of National Statistics. The GRACE score could be calculated in 270 patients with a confirmed diagnosis of NSTEMI. Of the 304 probable patients with NSTEMI, there were 5 in-hospital deaths (1.6%). Survival at 6 months was higher than GRACE predicted mortality in all groups. At 6 months the predicted versus observed mortality in the low-risk group was 4 versus 2% (P=0.05), in the medium-risk group it was 12.5 versus 1.9% (P=0.0001) and in the high-risk group it was 25 versus 20% (P=0.45). In-hospital CABG performed after NSTEMI is associated with a low-mortality risk and survival significantly better than that predicted by the GRACE score.
Highlights
The Global Registry of Acute Coronary Events (GRACE) study was a collaboration between 94 hospitals in 14 countries to describe the epidemiology, management, in-hospital and late follow-up of the entire spectrum of acute coronary syndromes (ACSs) [1]
The GRACE score could be calculated in 270 patients with a confirmed diagnosis of non-ST elevation myocardial infarction (NSTEMI)
In-hospital coronary artery bypass graft (CABG) performed after NSTEMI is associated with a low-mortality risk and survival significantly better than that predicted by the GRACE score
Summary
The Global Registry of Acute Coronary Events (GRACE) study was a collaboration between 94 hospitals in 14 countries to describe the epidemiology, management, in-hospital and late follow-up of the entire spectrum of acute coronary syndromes (ACSs) [1]. In the GRACE registry, 25% of patients enrolled were diagnosed with a non-ST elevation-ACS (NSTEMI) defined as the presence of ≥1 positive cardiac biochemical marker of necrosis without new ST-segment elevation seen on the index ECG. Fifty-three per cent of patients with NSTEMI underwent in-hospital angiography, with 28% undergoing percutaneous intervention (PCI) (87% receiving >1 bare metal stent) and 10% undergoing in-hospital coronary artery bypass grafting (CABG). The GRACE risk score is a simple bedside tool designed to predict the in-hospital and the 6-month outcome for patients admitted with ACS, with the intention of guiding the appropriate treatment algorithm [2].
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