title: Clinical effectiveness of the systematic use of the GRACE scoring system (in addition to clinical assessment) for ischaemic outcomes and bleeding complications in the management of NSTEMI compared with clinical assessment alone: a prospective study.
abstract: We assessed the interest of systematically using the GRACE scoring system (in addition to clinical assessment) for in- hospital outcomes and bleeding complications in the management of NSTEMI compared with clinical assessments alone. Multicentre, randomized study that included 572 consecutive NSTEMI patients, randomized 1:1, into group A: clinical stratification alone and group B: clinical+ GRACE score stratification.
  
  
  METHODS
  in-hospital outcomes and bleeding complications. There was no significant difference between the two groups for baseline data or for in-hospital MACE. In multivariate analysis, only a GRACE >140 (OR: 3.5, 95 % CI: 1.8-6.6, p < 0.001) and PCI (OR: 0.55, 95 % CI: 0.3-1.0; p = 0.05) were independent predictors of in-hospital MACE. The sub-analysis of group B showed that 56 patients (20 %) were given a compliance score of 0, showing that diagnostic angiography was performed later than as recommended by the guidelines. Interestingly, 91 % had a GRACE score >140, and these patients were significantly older, and were more likely to have a history of diabetes, stroke and renal failure, together with symptoms of heart failure. After multivariate analysis, the independent predictors of a lack of compliance with guideline delays were a GRACE score >140 (OR: 9.2; CI: 4.2-20.3, p < 0.001) and secondary referral from a non-PCI cardiology department (OR: 2.7; CI: 1.4-5.2, p = 0.003). In a real-world setting of patients admitted with NSTEMI, the systematic use of the GRACE scoring system at admission in the PCI centre does not improve in-hospital outcomes and bleeding complications.
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France. charles.guenancia@gmail.com.|LPPCM, INSERM U866, University of Burgundy, Dijon, France. charles.guenancia@gmail.com.
authors.forename: Charles
authors.identifier: http://orcid.org/0000-0002-3554-7714
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.|LPPCM, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Stamboul
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.|LPPCM, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hachet
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Yameogo
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Garnier
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.|LPPCM, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gudjoncik
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.|LPPCM, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Department of Cardiology, University Hospital, Dijon, France.|LPPCM, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003661:Decision Support Techniques; D005260:Female; D005602:France; D019983:Guideline Adherence; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: GRACE score; Myocardial infarction; NSTEMI; Risk stratification