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Acute coronary syndromes in young people: applicability of the GRACE and CRUSADE scores
Session:
Posters (Sessão 1 - Écran 3) - Doença Cardiovascular em Populações Especiais 1
Speaker:
Lisa Maria Ferraz
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Lisa Maria Ferraz; Pedro Carvalho; Diana Carvalho; Raquel Ferreira; em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: There is scarse information regarding the use GRACE and CRUSADE scores in acute coronary syndromes without ST-segment elevation (NSTEMI) occurring at an early age.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Purpose: To identify the main predictors of in-hospital mortality and major bleeding during hospitalization in patients (P) with NSTEMI and early age, and assess the adequacy of GRACE and CRUSADE risk scores in this population.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Retrospective study of 3106 consecutive P included in the National Registry of Acute Coronary Syndromes diagnosed with NSTEMI at an early age (men <55 and women <65 years), between October 1, 2010 and December 31, 2020: 65% (n=2018) men, 50±7 years. Demographics, cardiovascular risk factors, clinical and laboratorial parameters, medication, coronary angiography<span style="color:red">,</span> complications, GRACE and CRUSADE scores were evaluated. The main predictors of in-hospital mortality (IM) and major bleeding (MB) were evaluated and the adequacy of the GRACE and CRUSADE risk scores was analyzed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: Female gender (64,3 vs 33,3%, p<0,001), renal failure (14,3 vs 2,8%, p<0,001) and left ventricular systolic function <50% (53,8 vs 21,7%, p<0,001) were independent predictors of MB. The mean CRUSADE score was 17±13, with 132 P (6%) with CRUSADE score ≥41. MB occurred in 14 P of which 35,7% had CRUSADE score ≤20; 14,3% CRUSADE score between 21 and 30; 28,6% CRUSADE score between 31 and 40 and 21,4% had CRUSADE score ≥51. The presence of previous angina pectoris (55,6 vs 21,1%, p=0,004) and acute myocardial infarction (55,6 vs 17,5%, p=0,007) were predictors of IM. Survival during hospitalization was associated with the most frequent medication with beta-blockers (88,3 vs 55,6%, p<0,001) and iACE/ARA (85,5 vs 55,6%, p<0,001), a Killip Kimball class I at admission (95,7 vs 77,8%, p<0,001) and the absence of left main coronary artery disease (97,8 vs 66,7%, p<0,001). The mean GRACE score was 102±25, with 167 P (6,7%) with GRACE score > 140. IM occured in 10 P of which 33,3% had GRACE score ≤ 108; 33,3% GRACE score 109-140 and 33,3% GRACE score >140. On ROC curve analysis, there was a moderate diagnostic acuity of the GRACE score to identify P with in-hospital death (AUC 0,69, 95%CI 0,50–0,89, p=0,048), and of the CRUSADE score to identify P with MB (AUC 0,68, 95%CI 0,52–0,84, p=0,02).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: For NSTEMI ocurring at an early age, the scores GRACE and CRUSADE were not able to correctly classify most P at risk of IM and MB, respectively, and showed only a moderate discriminative capability for these events. These data suggest the need for new scores, adjusted for this age group.</span></span></p>
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