title: Risk-prediction model for ischemic stroke in patients hospitalized with an acute coronary syndrome (from the global registry of acute coronary events [GRACE]).
abstract: The risk of stroke in patients hospitalized with an acute coronary syndrome (ACS) ranges from <1% to ≥ 2.5%. The aim of this study was to develop a simple predictive tool for bedside risk estimation of in-hospital ischemic stroke in patients with ACS to help guide clinicians in the acute management of these high-risk patients. Data were obtained from 63,118 patients enrolled from April 1999 to December 2007 in the Global Registry of Acute Coronary Events (GRACE), a multinational registry involving 126 hospitals in 14 countries. A regression model was developed to predict the occurrence of in-hospital ischemic stroke in patients hospitalized with an ACS. The main study outcome was the development of ischemic stroke during the index hospitalization for an ACS. Eight risk factors for stroke were identified: older age, atrial fibrillation on index electrocardiogram, positive initial cardiac biomarkers, presenting systolic blood pressure ≥ 160 mm Hg, ST-segment change on index electrocardiogram, no history of smoking, higher Killip class, and lower body weight (c-statistic 0.7). The addition of coronary artery bypass graft surgery and percutaneous coronary intervention into the model increased the prediction of stroke risk. In conclusion, the GRACE stroke risk score is a simple tool for predicting in-hospital ischemic stroke risk in patients admitted for the entire spectrum of ACS, which is widely applicable to patients in various hospital settings and will assist in the management of high-risk patients with ACS.
authors.affiliation: Departments of Medicine, Surgery, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Kay Lee
authors.initials: KL
authors.lastname: Park
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Brian M
authors.initials: BM
authors.lastname: Kennelly
authors.forename: Enrique P
authors.initials: EP
authors.lastname: Gurfinkel
authors.forename: Gordon
authors.initials: G
authors.lastname: Fitzgerald
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D004562:Electrocardiography / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016019:Survival Analysis