Treatment and Outcomes of Patients With Suspected Acute Coronary Syndromes in Relation to Initial Diagnostic Impressions (Insights from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE])

被引：24

作者：

Bajaj, Ravi R. ^{[1
,2
]}

Goodman, Shaun G. ^{[1
,2
,3
]}

Yan, Raymond T. ^{[2
]}

Bagnall, Alan J. ^{[4
]}

Gyenes, Gabor ^{[5
]}

Welsh, Robert C. ^{[5
]}

Eagle, Kim A. ^{[6
]}

Brieger, David ^{[7
]}

Ramanathan, Krishnan ^{[8
]}

Grondin, Francois R. ^{[9
]}

Yan, Andrew T. ^{[1
,2
]}

机构：

[1] St Michaels Hosp, Dept Med, Terrence Donnelly Heart Ctr, Toronto, ON M5B 1W8, Canada

[2] Univ Toronto, Toronto, ON, Canada

[3] Canadian Heart Res Ctr, Toronto, ON, Canada

[4] Freeman Rd Hosp, Newcastle Upon Tyne NE7 7DN, Tyne & Wear, England

[5] Univ Alberta Hosp, Mazankowski Alberta Heart Inst, Edmonton, AB T6G 2B7, Canada

[6] Univ Michigan, Med Ctr, Ann Arbor, MI USA

[7] Univ Sydney, Concord Hosp, Sydney, NSW 2006, Australia

[8] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[9] Hotel Dieu Levis, Levis, PQ, Canada

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2013年 / 111卷 / 02期

关键词：

BASE-LINE CHARACTERISTICS; TIMI RISK SCORE; MYOCARDIAL-INFARCTION; CHEST-PAIN; MANAGEMENT-PRACTICES; HOSPITAL OUTCOMES; AMERICAN-COLLEGE; UNSTABLE ANGINA; MORTALITY; STRATIFICATION;

D O I：

10.1016/j.amjcard.2012.09.018

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The early diagnosis of acute coronary syndrome (ACS) remains challenging, and a considerable proportion of patients are diagnosed with "possible" ACS on admission. The Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 16,618 Canadian patients with suspected ACS in 1999 to 2008. We compared the demographic and clinical characteristics, use of cardiac procedures, prognostic accuracy of the GRACE risk score, and in-hospital outcomes between patients given an admission diagnosis of "definite" versus "possible" ACS by the treating physician. Overall, 11,152 and 5,466 patients were given an initial diagnosis of "definite" ACS and "possible" ACS, respectively. Patients with a "possible" ACS had higher GRACE risk score (median 130 vs 125) and less frequently received aspirin, clopidogrel, heparin, or beta blockers within the first 24 hours of presentation and assessment of left ventricular function, stress testing, cardiac catheterization, and percutaneous coronary intervention (all p <0.05). Patients with "possible" ACS had greater rates of in-hospital myocardial infarction (9.0% vs 2.0%, p <0.05) and heart failure (12% vs 8.9%, p <0.05). The GRACE risk score demonstrated excellent discrimination for in-hospital mortality in both groups and for the entire study population. In conclusion, compared to patients with "definite" ACS on presentation, those with "possible" ACS had higher baseline GRACE risk scores but less frequently received evidence-based medical therapies within 24 hours of admission or underwent cardiac procedures during hospitalization. The GRACE risk score provided accurate risk assessment, regardless of the initial diagnostic impression. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:202-207)

引用

页码：202 / 207

页数：6

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