Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
Congresso Português de Cardiologia 2023 (CPC2023)
Congresso Português de Cardiologia 2024 (CPC2024)
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
The superiority of GRACE in predicting cardiogenic shock and in-hospital mortality in STEMI
Session:
Posters 4 - Écran 1 - Doença Coronária
Speaker:
Mafalda Carrington
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Ana Rita Santos; Antonio; Bruno Cordeiro Piçarra; Diogo Brás; Rui Azevedo Guerreiro; Kisa Hyde Congo; José Eduardo Aguiar; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><u>INTRODUCTION:</u> Traditionally, TIMI is used for stratification of in-hospital mortality (IHM) in ST-elevation myocardial infarction (STEMI) and GRACE in non-STEMI patients. A Simple Clinical Score (SCS) validated in the Swedish population, which included clinical variables at admission was associated to higher IHM in patients with MI. On the other side, we still have few tools to predict cardiogenic shock (CS) and none of the scores was studied for this outcome.</p> <p><u>PURPOSE:</u> To assess the ability of GRACE and SCS to predict IHM and CS in a STEMI Portuguese population, as compared to TIMI. We aimed to create a cut-off point to help clinicians define a higher-risk group of patients for each score and for each outcome. </p> <p><u>METHODS:</u> Consecutive patients who were admitted with suspected STEMI were identified through a national multicentric national registry. We excluded patients with cardiac arrest or CS prior to admission. We defined IHM as primary outcome and CS as a secondary outcome. We calculated GRACE and TIMI for each patient, as well as a SCS by using the following variables: age≥50 years (1 point), male sex (1 point), ST-T abnormalities (2 points), Killip Class>1 (2 points), heart rate<40 or ≥100bpm (2 points), and systolic blood pressure <100mmHg (4 points). The area under the ROC curve (AUC) assessed the discrimination power of the scores. We identified the most appropriate cut-off values based on the point where the Youden’s Index was maximum, thus creating high-risk groups for each clinical event. Logistic regression models evaluated independent association of high risk scoring with the studied events. </p> <p><u>RESULTS:</u> We included 5294 patients with STEMI, in which GRACE score was better than both TIMI and the SCS at predicting both IHM (AUC: GRACE 0,866 (IC95% 0.856-0.805) versus TIMI 0,837 (IC95% 0,827-0,847), p=0.009; GRACE vs SCS 0,692 (IC95% 0,679-0,704), p<0.001) and CS (AUC: GRACE 0,794 (IC95% 0,783-0,805) vs TIMI 0,771 (IC95% 0,759-0,782), p=0,029; GRACE vs SCS 0,687 (IC95% 0,674-0,699), p<0,001) (see Table 1). Additionally, comparing to TIMI, the SCS was worse at predicting IHM and CS (p<0.001). According to the most appropriate cut-off points identified, logistic regression models showed that patients with GRACE≥184 (OR 4,46; IC95% 2,60-7,64) and TIMI≥6 (OR 2,55 IC95% 1,55-4,18) had, respectively, 4,5 and 2,6 times higher risk for IHM than patients with lower scores. On the other side, GRACE≥173 (OR 1,82; IC95% 1,04-3,20) increased 1,8 times the risk to develop CS. It was not possible to define a cut-off point for the SCS. </p> <p><u>CONCLUSIONS:</u> In STEMI patients, all scores studied performed well at predicting IHM and CS. Even if GRACE score is not well validated for STEMI, it performed better than TIMI at predicting both IHM and CS, and TIMI did better than the SCS. Patients with high-risk scores according to the defined cut-offs may need closer monitoring and more aggressive therapy. </p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site