Regular paperImpact of aspirin on presentation and hospital outcomes in patients with acute coronary syndromes (The Global Registry of Acute Coronary Events [GRACE])☆
Section snippets
Methods
Full details of the GRACE rationale and methods have been previously published1 and are outlined in the following.
Results
The study population consisted of 11,388 men and women with acute coronary syndrome, enrolled in GRACE from July 1999 to June 2001, for whom information about long-term use of ASA was available. A total of 4,974 patients (43.7%) had a history of CAD, whereas 6,414 patients did not. Among the patients with a history of CAD, 3,629 (73.0%) were on long-term ASA therapy, whereas 1,243 (19.4%) of those without a history of CAD had been on ASA. Regional differences in the prior use of ASA in patients
Use of asa and its impact in patients without a history of cad:
The Physicians Health Study and the British Doctors’ Study both documented impressive reductions in the risk of an initial MI (∼32%) in healthy men randomized to ASA treatment, but these studies were unable to show significant reductions in stroke or cardiovascular mortality.4, 5 More recently, a randomized 2 × 2 trial examining the use of ASA and vitamin E therapy in 4,495 patients with ≥1 cardiac risk factors, but without clinically apparent CAD, was discontinuted prematurely after 3.6 years
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Cited by (47)
Acute coronary syndrome in the Asia-Pacific region
2016, International Journal of CardiologyCitation Excerpt :While mortality rates at 6 months post-discharge, for example, were comparable with in-hospital rates (~ 5%), optimal revascularization and statin use could prevent up to 32% and 10% of deaths by 6 months, respectively [23]. Greatest survival at 6 months was associated with timely CABG (odds ratio [OR] for death 0.60; 95% confidence interval [CI] 0.39–0.90) and PCI (OR 0.57; CI 0.48–0.72), and use of clopidogrel (OR 0.84; CI 0.72–0.99) and statins (OR 0.85; CI 0.73–0.99) [56,57]. In terms of national economic status, the Organization to Assess Strategies for Ischemic Syndromes (OASIS)-1 (low- and middle-income countries, 1995–1996) and OASIS-2 (middle- and high-income countries, 1999–2000) registries – both 2-year prospective studies of outcomes in NSTE-ACS patients [19] – show little difference in 2-year mortality, despite wide variability in management practices.
Complications in the clinical course of tako-tsubo cardiomyopathy
2014, International Journal of CardiologyCitation Excerpt :The complication rate is higher than in contemporary registries of patients with both NSTEMI [18] and STEMI [19]. However, severe complications such as heart failure and death occurred less frequently than in a registry of ACS patients (GRACE) [20]. Overall, TTC should be regarded as a clinical entity with a potentially complicated clinical course similar to that in ACS.
Relation of aspirin failure to clinical outcome and to platelet response to aspirin in patients with acute myocardial infarction
2011, American Journal of CardiologyCitation Excerpt :The Thrombolysis In Myocardial Infarction risk score recognizes previous aspirin use as an independent risk factor for adverse outcomes in subjects presenting with ACS.7 Indeed, most3,6,8,9,11 but not all2,4,5,12 studies have demonstrated worse clinical outcomes in patients presenting with aspirin failure. Our present findings, which show a significantly worse outcome at 6-month follow-up, are consistent with the results of these studies.3,6,8,9,11
Prior aspirin use and outcomes in acute coronary syndromes
2010, Journal of the American College of CardiologyCitation Excerpt :More recent analyses have arrived at conclusions in conflict with those in the aforementioned studies. Spencer et al. (33) analyzed ACS patients in the GRACE (Global Registry of Acute Coronary Events) registry and found that in patients with a history of CAD, prior aspirin use was associated with a lower total mortality and other short-term adverse outcomes during the index hospitalization. Portnay et al. (34) analyzed a large registry of Medicare patients with a diagnosis of acute MI and found that prior aspirin use was associated with fewer deaths at both 1 and 6 months after an ACS.
Impact of antecedent aspirin use on infarct size, bleeding and composite endpoint in patients with de novo acute myocardial infarction
2021, Therapeutics and Clinical Risk Management
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The GRACE project is supported by an unrestricted educational grant from Aventis Pharmaceuticals, Philadelphia, Pennsylvania.