The prognostic utility of GRACE risk score in predictive cardiovascular event rate in STEMI patients with successful fibrinolysis and delay intervention in non PCI-capable hospital: a retrospective cohort study.
Fibrinolytic therapy is the main reperfusion therapy for most STEMI patients in several countries. Current practice guidelines recommended routine early pharmacoinvasive (within 3-24 h after successful fibrinolysis, however it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. This study aimed to evaluate the prognostic utility of the GRACE score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospital.



We retrospectively analysed the data from the Maharaj Nakorn Chiang Mai Hospital acute ST-elevation myocardial infarction (STEMI) registry during the period 2007-2012. The STEMI patients who had successfully fibrionolysis in non PCI-capable hospital and received delayed PCI (during 24 h to 14 days after successful fibrinolytic therapy) at Maharaj Nakorn Chiang Mai hospital were included. The primary end point for this analysis was the composite outcomes, which included all-cause mortality, re-hospitalization with acute coronary syndrome (ACS), re-hospitalization with heart failure (HF) and stroke at 1 and 6-month.



A total of 152 patients were included. 88 patients and 64 patients were in low GRACE group (GRACE risk score ≤ 125) and intermediate to high GRACE group (GRACE risk score above 126), respectively. The median time from fibrinolysis to coronary intervention in low GRACE group was 8.5 days (interquartile range, 4.6-10.9) and 7.9 days (interquartile range,3.2,12.0) in intermediate to high GRACE group (p = 0.482). At 1 month, the composite cardiovascular outcome at 1 month occurred in 2 patients (2.3 %) in low GRACE group and 10 patients (15.6 %) in intermediate to high GRACE group (P = 0.003). During 6 months, the composite cardiovascular outcomes occurred in 6 patients (6.8 %) in low GRACE group and 12 patients (18.7 %) in intermediate to high GRACE group (P = 0.024). The cumulative of composite cardiovascular outcome was significant higher in intermediate to high GRACE group than in low GRACE group (Hazard ratio: 2.97, 95 % CI 1.11-7.90; p = 0.030).



The long delay pharmacoinvasive strategy in intermediate to high GRACE score after successful fibrinolysis in non PCI-capable facilities were associated with worse cardiovascular outcomes than the patients with low GRACE score at 1 and 6 months. GRACE risk score may be helpful and guided the clinicians in non PCI-capable center in early transferred to early intervention in STEMI patients after fibrinolytic therapy.
Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.|Cardiology Division, Internal Medicine Department, Lampang Hospital, Lampang, 52000, Thailand.
Yotsawee
Y
Chotechuang
Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. arintaya.p@cmu.ac.th.
Arintaya
A
Phrommintikul
Pharmaceutical Care Unit, Pharmacy Department, Lampang Hospital, Lampang, 52000, Thailand.
Roungtiva
R
Muenpa
Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Bangkok, 12121, Thailand.
Jayanton
J
Patumanond
Cardiac catheterization laboratory Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 50200.
Tuanchai
T
Chaichuen
Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Srun
S
Kuanprasert
Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Noparat
N
Thanachikun
Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Thanawat
T
Benjanuwatra
Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Apichard
A
Sukonthasarn
D054058:Acute Coronary Syndrome / Q000209:etiology / Q000628:therapy; D000368:Aged; D019540:Area Under Curve; D017023:Coronary Angiography; D003661:Decision Support Techniques; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000209:etiology / Q000628:therapy; D013785:Thailand; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
Delay pharmacoinvasive strategy; GRACE risk score; STEMI patients with successfully fibrinolysis