Introduction
Methods
Study population
GRACE risk scores
-
Original GRACE risk score estimating the risk for in-hospital death,
-
GRACE 1.0 estimating the risk for in-hospital death,
-
GRACE 1.0 estimating the risk for death at 6 months,
-
GRACE 1.0 estimating the combined risk for death or myocardial infarction at 6 months, and
-
GRACE 2.0 estimating the risk for death at 6 months.
Measurements of hs-cTnT
ESC 0/1 h-algorithm
Outcome measures and follow-up
Statistical analyses
Results
All (n = 8618) | Low (n = 4516) | Intermediate (n = 2120) | High (n = 1982) | p | |
---|---|---|---|---|---|
Male, % | 5658 (65.7) | 3078 (68.2) | 1352 (63.8) | 1228 (62.0) | < 0.001 |
BMI, kg/m2 | 26.4 (23.8, 29.6) | 26.3 (23.6, 29.6) | 26.8 (24.2, 29.9) | 26.2 (23.7, 29.4) | < 0.001 |
GRACE variables | |||||
Age, years | 62.0 (49.0, 74.0) | 51.0 (42.0, 59.0) | 70.0 (61.4, 76.0) | 78.0 (72.0, 83.0) | < 0.001 |
Heart rate, min−1 | 76.0 (66.0, 89.0) | 76.0 (66.0, 87.0) | 75.0 (65.0, 88.0) | 80.0 (69.0, 97.0) | < 0.001 |
Systolic blood pressure, mmHg | 142.0 (127.0, 158.0) | 143.0 (129.0, 160.0) | 145.0 (130.0, 159.0) | 134.0 (118.0, 151.0) | < 0.001 |
Killip class | < 0.001 | ||||
I | 6875 (79.8) | 4268 (94.5) | 1660 (78.3) | 947 (47.8) | |
II | 1463 (17.0) | 235 (5.2) | 406 (19.2) | 822 (41.5) | |
III | 263 (3.1) | 13 (0.3) | 54 (2.5) | 196 (9.9) | |
IV | 17 (0.2) | 0 (0) | 0 (0) | 17 (0.9) | |
Creatinine, µmol/l | 79.0 (67.0, 94.6) | 74.0 (64.0, 85.7) | 80.4 (69.0, 97.0) | 96.0 (78.0, 121.0) | < 0.001 |
ST-segment deviation, % | 1756 (20.4) | 292 (6.5) | 514 (24.2) | 950 (47.9) | < 0.001 |
Hs-cTnT (Roche) > 14 ng/L, % | 2782 (32.3) | 381 (8.4) | 840 (39.6) | 1561 (78.8) | < 0.001 |
Cardiac arrest, % | 36 (0.4) | 0 (0) | 4 (0.2) | 32 (1.6) | < 0.001 |
Medical history | |||||
History of myocardial infarction, % | 1807 (21.0) | 602 (13.3) | 515 (24.3) | 690 (34.8) | < 0.001 |
History of coronary artery disease, % | 2809 (32.6) | 890 (19.7) | 866 (40.8) | 1,053 (53.1) | < 0.001 |
Hypertension, % | 5272 (61.2) | 2045 (45.3) | 1565 (73.9) | 1662 (83.9) | < 0.001 |
Hyperlipoproteinemia, % | 3742 (43.4) | 1469 (32.5) | 1113 (52.5) | 1160 (58.5) | < 0.001 |
Current smoker, % | 2078 (24.2) | 1448 (32.2) | 386 (18.3) | 244 (12.4) | < 0.001 |
Peripheral artery disease, % | 470 (5.5) | 87 (1.9) | 140 (6.6) | 243 (12.3) | < 0.001 |
Stroke, % | 478 (5.5) | 112 (2.5) | 155 (7.3) | 211 (10.7) | < 0.001 |
Atrial fibrillation, % | 760 (8.8) | 96 (2.1) | 191 (9.0) | 473 (23.9) | < 0.001 |
Laboratory findings | |||||
hs-TnT 0 h, ng/l | 8.0 (4.0, 20.0) | 5.0 (3.0, 8.0) | 12.0 (7.0, 22.2) | 26.0 (16.0, 59.0) | < 0.001 |
eGFR, ml/min/1.73 m2 | 85.1 (66.4, 99.2) | 96.7 (84.4, 107.2) | 78.0 (63.5, 89.7) | 59.3 (44.2, 77.0) | < 0.001 |
ECG findings | |||||
ST-segment depression, % | 823 (9.6) | 95 (2.1) | 237 (11.2) | 491 (25.1) | < 0.001 |
T-wave inversion, % | 987 (11.5) | 150 (3.3) | 299 (14.2) | 538 (27.5) | < 0.001 |
No significant ECG changes, % | 6,812 (79.7) | 4,199 (93.6) | 1597 (75.7) | 1016 (52.0) | < 0.001 |
GRACE risk scores
Risk reclassification
Risk category | Original GRACE risk score estimating the risk for in-hospital death | |||
---|---|---|---|---|
Low | Intermediate | High | ||
Score, outcome | Percent of patients | 52.4 | 24.6 | 23.0 |
GRACE 1.0, in-hospital death | Low | 6.5 | 0 | |
Intermediate | 0.1 | 0 | ||
High | 0 | 2.2 | ||
GRACE 1.0, death within 6 months | Low | 63.8 | 0.5 | |
Intermediate | 0 | 51.8 | ||
High | 0 | 0 | ||
GRACE 1.0, death or MI within 6 months | Low | 18.7 | 0.2 | |
intermediate | 5.7 | 4.1 | ||
High | 0.002 | 29.6 | ||
GRACE 2.0, death within 6 months | Low | 67.9 | 1.8 | |
Intermediate | 0.02 | 53.7 | ||
High | 0 | 0 |