Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)

doi:10.1016/S0002-9149(02)02489-X

The American Journal of Cardiology

Volume 90, Issue 4, 15 August 2002, Pages 358-363

https://doi.org/10.1016/S0002-9149(02)02489-X Get rights and content

Abstract

Acute coronary syndrome (ACS) represents a heterogenous spectrum of conditions. The Global Registry of Acute Coronary Events (GRACE) describes the epidemiology, management, and outcomes of patients with ACS. Data were collected from 11,543 patients enrolled in 14 countries. Of these patients, 30% had ST-segment elevation myocardial infarction (STEMI), 25% had non–ST-segment elevation myocardial infarction (NSTEMI), 38% had unstable angina pectoris, and 7% had other cardiac or noncardiac diagnoses. Over half of these patients (53%) were ≥65 years old. Reperfusion therapy was used in 62% of patients with STEMI. Percutaneous coronary intervention was performed in 40% of these subjects during the index admission. Intravenous glycoprotein IIb/IIIa blockers were used in 23%, 20%, and 7% of patients with STEMI, NSTEMI, and unstable angina, respectively (STEMI vs NSTEMI, p = 0.0018, and for either group vs unstable angina, p <0.001). Coronary artery bypass grafting was performed in 4%, 10%, and 5% of patients, respectively (p <0.0001). Hospital case fatality rates were markedly different among patients with STEMI, NSTEMI, and unstable angina (7%, 6%, and 3%, respectively; STEMI vs NSTEMI, p = 0.0459, and for either group vs unstable angina, p <0.001). Congestive heart failure complicated the hospital course in 18%, 18%, and 10% of the patients, respectively (p <0.0001), and recurrent angina with ST-segment changes occurred before discharge in 10%, 10%, and 9% of patients, respectively (p = 0.2644). GRACE provides a detailed and comprehensive global description of the spectrum of patients with ACS.

Section snippets

Methods

Full details of the GRACE rationale and methods have been previously published1 and are outlined briefly as follows. A total of 95 hospitals organized into 18 clusters in 14 countries in North and South America, Europe, Australia, and New Zealand are currently collaborating in GRACE. Clusters were chosen based on local demographic characteristics and hospital facilities to ensure a representative sample of patients with ACS from each country and hospital systems of different sizes and treatment

Results

Enrollment in GRACE started in April 1999 and involved 95 institutions (Table 1). At admission, patients were assigned a working diagnosis of myocardial infarction, unstable angina, rule-out myocardial infarction, or chest pain. The present study includes a total of 11,543 patients enrolled by the end of December 31, 2000. Using the prespecified diagnostic criteria described previously, cases were subsequently divided into those with STEMI (30%), NSTEMI (25%), unstable angina (38%), or other

Discussion

The management of ACS has been well defined by clinical trials and summarized in reviews4, 5 and guidelines.6, 7, 8, 9 However, “real life” patient populations sometimes differ markedly from those in clinical trials.10 In addition, there is considerable heterogeneity in patient management practices.11 Therefore, large-scale observational data sets, such as GRACE, are important to complement the information obtained via randomized clinical trials.

One potential value of registry data is the

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The study included 249 patients within 14 days after MI with left ventricular ejection fraction (LVEF) ≤35% at discharge in 11 hospitals in India. Patients received a wearable external loop recorder (ELR) 5 ± 3 days after MI to monitor arrhythmias for 7 days.
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Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention.
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Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55–75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.
Même dans les pays en développement comme le Népal, il a été démontré que la prévalence de l’infarctus du myocarde avec élévation de la ST augmente avec l’augmentation de la prévalence des facteurs de risque conventionnels comme le diabète, l’hypertension, le tabagisme, la dyslipidémie et l’obésité. Notre objectif est d’analyser rétrospectivement divers facteurs de risque et schémas angiographiques de la maladie coronarienne chez les patients atteints d’infarctus du myocarde avec élévation du ST subissant une intervention percutanée primaire.
Au cours de la période d’un an (janvier 2019 à décembre 2019), 816 patients se sont présentés à notre salle d’urgence avec une STEMI aiguë, parmi lesquels 437 (53,6 %) patients ont subi une stratégie primaire d’ICP et parmi eux 22 (5,3 %) sont décédés. Trente-six (4,4 %) patients ont reçu une thrombolyse, parmi eux 5 (13,9 %) patients sont décédés tandis que 343 (42,0 %) patients restants ont été traités de manière conservatrice et parmi eux 20 (5,8 %) sont décédés. L’âge moyen des patients ayant subi une ICP primaire était de 58,5 ± 12,7 ans, allant de 25 ans à 99 ans. Parmi eux, les 55–75 ans, 217 (49,6 %) étaient les plus nombreux suivis des < 55 ans 180 (41,2 %). Les hommes 318 (72,8 %) étaient prédominants. Parmi ceux qui ont subi une ICP primay, l’hypertension 214 (49 %) était le facteur de risque le plus courant, suivi du tabagisme 198 (45,3 %), du diabète sucré 123 (28,1 %), de la dyslipidémie 53 (12,1 %) et des antécédents familiaux d’artère coronaire prématurée maladie 18 (4,1 %). Parmi ces patients, 292 patients (66,8 %) avaient une maladie vasculaire unique, 99 patients (22,7 %) avaient une maladie des deux vaisseaux, 41 patients (9,3 %) avaient une maladie des trois vaisseaux et 5 patients (1,1 %) avaient une sténose coronarienne non significative. L’artère coupable la plus fréquemment retrouvée était la l’artère interventriculaire antérieure (53,3 %), suivie de l’artère coronaire droite, du circonflexe gauche, de la branche intermédiaire et de l’artère principale gauche.
Cinquante pour cent des patients ont présenté un infarctus du myocarde aigu avec élévation du ST et ont subi une ICP primaire étaient âgés de 55 à 75 ans. L’hypertension et le tabagisme étaient les facteurs de risque les plus courants chez ces patients. La maladie à un seul vaisseau était la plus fréquente, l’artère interventriculaire antérieure gauche étant la plus fréquemment atteinte, suivie de l’artère coronaire droite et du circonflexe gauche.

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^☆: GRACE is supported by an unrestricted educational grant from Aventis Pharma, Bridgewater, New Jersey.

^*: Further information about the project, along with a complete list of the study participants, can be found at www.outcomes.org/grace.

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Regular paperBaseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)*☆,

Abstract

Section snippets

Methods

Results

Discussion

Am J Med

Lancet

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Rationale and design of the GRACE (Global Registry of Acute Coronary Events) projecta multinational registry of patients hospitalized with acute coronary syndromes

Am Heart J

Objectives and design

Int J Epidemiol

Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents

Circulation

Acute coronary syndromes. Unstable angina and non-Q-wave myocardial infarction

Circulation

Regular paper
Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)*☆,