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Treatment and Outcomes of Patients With Suspected Acute Coronary Syndromes in Relation to Initial Diagnostic Impressions (Insights from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE])

Lookup NU author(s): Dr Alan Bagnall

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Abstract

The early diagnosis of acute coronary syndrome (ACS) remains challenging, and a considerable proportion of patients are diagnosed with "possible" ACS on admission. The Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 16,618 Canadian patients with suspected ACS in 1999 to 2008. We compared the demographic and clinical characteristics, use of cardiac procedures, prognostic accuracy of the GRACE risk score, and in-hospital outcomes between patients given an admission diagnosis of "definite" versus "possible" ACS by the treating physician. Overall, 11,152 and 5,466 patients were given an initial diagnosis of "definite" ACS and "possible" ACS, respectively. Patients with a "possible" ACS had higher GRACE risk score (median 130 vs 125) and less frequently received aspirin, clopidogrel, heparin, or beta blockers within the first 24 hours of presentation and assessment of left ventricular function, stress testing, cardiac catheterization, and percutaneous coronary intervention (all p <0.05). Patients with "possible" ACS had greater rates of in-hospital myocardial infarction (9.0% vs 2.0%, p <0.05) and heart failure (12% vs 8.9%, p <0.05). The GRACE risk score demonstrated excellent discrimination for in-hospital mortality in both groups and for the entire study population. In conclusion, compared to patients with "definite" ACS on presentation, those with "possible" ACS had higher baseline GRACE risk scores but less frequently received evidence-based medical therapies within 24 hours of admission or underwent cardiac procedures during hospitalization. The GRACE risk score provided accurate risk assessment, regardless of the initial diagnostic impression. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:202-207)

Publication metadata

Author(s): Bajaj RR, Goodman SG, Yan RT, Bagnall AJ, Gyenes G, Welsh RC, Eagle KA, Brieger D, Ramanathan K, Grondin FR, Yan AT, Canadian GRACE Investigators, Canadian CANRACE Investigators

Publication type: Article

Publication status: Published

Journal: American Journal of Cardiology

Year: 2013

Volume: 111

Issue: 2

Pages: 202-207

Print publication date: 15/01/2013

Online publication date: 01/11/2012

Acceptance date: 11/09/2012

ISSN (print): 0002-9149

ISSN (electronic): 1879-1913

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.amjcard.2012.09.018

DOI: 10.1016/j.amjcard.2012.09.018

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