Clinical InvestigationAcute Ischemic Heart DiseaseThe diagnostic and prognostic impact of the redefinition of acute myocardial infarction: Lessons from the Global Registry of Acute Coronary Events (GRACE)
Section snippets
Study design
Full details of the GRACE rationale and methodology have been published.9, 10, 11 In brief, GRACE is designed to reflect an unbiased population of patients with ACS, irrespective of geographic region. Currently, 94 hospitals located in 14 countries (Argentina, Australia, Austria, Belgium, Brazil, Canada, France, Germany, Italy, New Zealand, Poland, Spain, United Kingdom, United States) are participating in this observational study.
Patients entered in the registry had to be at least 18 years old
Final clinical diagnoses
Of 26 267 patients enrolled in GRACE, 15 760 (60.0%) were diagnosed with acute MI based upon elevated levels of at least 1 cardiac marker. Unstable angina (no elevation of cardiac markers) was diagnosed in 8549 patients (32.5%), and the remaining 1958 (7.5%) had another cardiac or noncardiac final diagnosis.
Creatine kinase–MB and cardiac troponin status, and hospital events
Of the 10 719 patients from whom data on both CK-MB and cardiac troponin levels were available, 23.5% had CK-MB levels of less than the ULN and were also troponin negative (ie, troponin levels
Discussion
In this large, multinational, prospective registry of less selected patients with suspected ACS, the addition of initial and/or peak cardiac troponin–positive status to the standard cardiac enzyme evaluation resulted in as many as 1 in 4 additional patients (range 10.4%-29%) meeting the recently recommended criteria for acute MI. Even when the status of the specific enzyme CK-MB was used, cardiac troponin–positive status led to approximately 1 in 10 additional patients previously labeled with a
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2021, International Journal of Radiation Oncology Biology PhysicsPeriprocedural Myocardial Infarction in Contemporary Practice
2019, Interventional Cardiology ClinicsFourth Universal Definition of Myocardial Infarction (2018)
2018, Global HeartCitation Excerpt :Using criteria less than conjoint analytical and biological variation will reduce the clinical specificity of hs-cTn assays [113,116]. An imprecision of ≤10% coefficient of variation (CV) at the 99th percentile URL is also mandatory for hs-cTn assays [31]. The use of non-hs-cTn assays that do not have imprecision (≤ 10% CV at the 99th percentile URL) makes the determination of a significant serial change more difficult but does not cause false positive results.
This research was funded by an unrestricted educational grant from Aventis Pharma, Bridgewater, NJ.
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A complete list of the GRACE Investigators is included in the Appendix A.