title: Comparison of the Global Registry of Acute Coronary Events Risk Score Versus the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse outcomes With Early Implementation of the ACC/AHA Guidelines Risk Score to Predict In-Hospital Mortality and Major Bleeding in Acute Coronary Syndromes.
abstract: Risk assessment plays a major role in the management of acute coronary syndrome. The aim was to compare the performance of the Global Registry of Acute Coronary Events (GRACE) and the Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the American College of Cardiology/American Heart Asociation guidelines (CRUSADE) risk scores to predict in-hospital mortality and major bleeding (MB) in 1,587 consecutive patients with acute coronary syndrome. In-hospital deaths and bleeding complications were prospectively collected. Bleeding complications were defined according to CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. During the hospitalization, 71 patients (4.5%) died, 37 patients (2.3%) had BARC MB and 34 patients (2.1%) had CRUSADE MB. Receiver operating characteristic curves analyses showed GRACE risk score has better discrimination capacity than CRUSADE risk score for both, mortality (0.86 vs 0.79; p = 0.018) and BARC MB (0.80 vs 0.73; p = 0.028), but similar for CRUSADE MB (0.79 vs 0.79; p = 0.921). Both scores had low discrimination for predicting MB in the elderly (>75 years) and patients with atrial fibrillation, whereas CRUSADE risk score was especially poor for predicting MB in patients with <60 ml/min/1.73 m(2) or those treated with new antiplatelets. Reclassification analyses showed GRACE risk score was associated with a significant improvement in the predictive accuracy of CRUSADE risk score for predicting mortality (net reclassification improvement: 22.5%; p <0.001) and MB (net reclassification improvement: 17.6%; p = 0.033) but not for CRUSADE MB. In conclusion, GRACE risk score has a better predictive performance for predicting both in-hospital mortality and BARC MB. In light of these findings, we propose the GRACE score as a single score to predict these in-hospital complications.
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain; Departamento de Medicina Interna, Universidad de Murcia, Spain. Electronic address: sergiosmf13@hotmail.com.
authors: Sergio
authors: S
authors: Manzano-Fernández
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: Marianela
authors: M
authors: Sánchez-Martínez
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: Pedro J
authors: PJ
authors: Flores-Blanco
authors: Departmento de Medicina Interna, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
authors: Ángel
authors: Á
authors: López-Cuenca
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: Miriam
authors: M
authors: Gómez-Molina
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: Francisco J
authors: FJ
authors: Pastor-Pérez
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: María J
authors: MJ
authors: Sánchez-Galian
authors: Departamento de Medicina Interna, Sección de Cardiología, Hospital de los Arcos, San Javier, Murcia, Spain.
authors: Francisco
authors: F
authors: Cambronero-Sanchez
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors: Esther
authors: E
authors: Guerrero Pérez
authors: Departamento de Bioquímica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors: Andrea
authors: A
authors: García-Narbón
authors: Departamento de Bioquímica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors: Ignacio
authors: I
authors: de Las Heras-Gómez
authors: Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Unversitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain; Departamento de Medicina Interna, Universidad de Murcia, Spain.
authors: Mariano
authors: M
authors: Valdés
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment