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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]).
Am J Cardiol. 2013 Jan 15; 111(2):202-7.AJ

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 β 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.

Authors+Show Affiliations

Department of Medicine, Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23122889

Citation

Bajaj, Ravi R., et al. "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])." The American Journal of Cardiology, vol. 111, no. 2, 2013, pp. 202-7.
Bajaj RR, Goodman SG, Yan RT, et al. 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]). Am J Cardiol. 2013;111(2):202-7.
Bajaj, R. R., Goodman, S. G., Yan, R. T., Bagnall, A. J., Gyenes, G., Welsh, R. C., Eagle, K. A., Brieger, D., Ramanathan, K., Grondin, F. R., & Yan, A. T. (2013). 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]). The American Journal of Cardiology, 111(2), 202-7. https://doi.org/10.1016/j.amjcard.2012.09.018
Bajaj RR, et al. 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]). Am J Cardiol. 2013 Jan 15;111(2):202-7. PubMed PMID: 23122889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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]). AU - Bajaj,Ravi R, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Bagnall,Alan J, AU - Gyenes,Gabor, AU - Welsh,Robert C, AU - Eagle,Kim A, AU - Brieger,David, AU - Ramanathan,Krishnan, AU - Grondin,Francois R, AU - Yan,Andrew T, AU - ,, Y1 - 2012/11/01/ PY - 2012/07/05/received PY - 2012/09/11/revised PY - 2012/09/11/accepted PY - 2012/11/6/entrez PY - 2012/11/6/pubmed PY - 2013/2/27/medline SP - 202 EP - 7 JF - The American journal of cardiology JO - Am J Cardiol VL - 111 IS - 2 N2 - 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 β 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. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/23122889/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]__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(12)02196-0 DB - PRIME DP - Unbound Medicine ER -