Key result
The GRACE risk score consistently upgraded the risk category of patients with acute coronary syndrome compared to the TIMI risk score, reclassifying 56% of patients to a higher risk category.
Why the study?
Coronary artery disease and acute coronary syndrome cause significant death and morbidity, motivating an assessment of demographic profiles, risk factors, management, and in-hospital outcomes in a tertiary care center.
Observational (n=100)
No
This observational study highlights the demographic and management profile of ACS patients in an Indian tertiary center, noting a high rate of PCI and a strong association of STEMI with tobacco abuse in younger patients.
Should not yet alter ACS risk stratification; leaves open whether GRACE reclassification improves outcomes.
Background: Death and morbidity are caused by coronary artery disease (CAD) and acute coronary syndrome (ACS), which include ST-elevation myocardial infarction (STEMI) and unstable angina (UA), are the most common causes of death among those with CAD. The aim of the study was to define the demographic profile of patients with ACS in a tertiary care center, to identify risk factors in the profile of patients with ACS, to learn about the management of ACS in tertiary health care centers, and to estimate in-hospital outcomes in ACS patients at a tertiary health care center. Methods: The study was carried out in the Cardiology Department of Batra hospital and Medical Research Center, New Delhi, India. The Research Ethics Committee of the Hospital reviewed and approved the study protocol. Data Collected Included: Sociodemographic data, anthropometric data, clinical history, significant past medical history, medications, current clinical status of the patient, and investigations including electrocardiogram (ECG), electrocardiogram (ECHO), and coronary artery graft. Results: Age groups and type of ACS were having a statistically significant association (p = 0.04). A majority of patients with ACS were seen in the 55-74 years age group. Tobacco abuse was more common in STEMI patients as compared to other types of ACS. There was significant variation between risk stratification of ACS patients by Thrombolysis in Myocardial Infarction and Global Registry of Acute Cardiac Events scores. Single vessel disease (SVD) patients dominated both the STEMI [26 (50.9%)] and UA [13 (52%)] groups. There was a highly significant association between a specific line of treatment and type of ACS (p < 0.0001). A majority of patients underwent percutaneous intervention (69% of 100). Coronary artery bypass graft (CABG) was done in five (5/100) patients only. Thrombolysis was advocated in three (5.7%) patients with Streptokinase (SK) and two patients with Tenecteplase (TNK). Conclusion: There was a marked preponderance of STEMI in younger patients but it was less marked in older patients, according to the study. All conventional risk factors were represented in all types of ACS but hypertension and tobacco abuse were more consistent risk factors associated with STEMI.
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Bhalerao et al. (2022) conducted an observational in Acute Coronary Syndrome (n=100). GRACE risk score vs. TIMI risk score was evaluated on Risk stratification variation between TIMI and GRACE scores (p=<0.0001). The GRACE risk score consistently upgraded the risk category of patients with acute coronary syndrome compared to the TIMI risk score, reclassifying 56% of patients to a higher risk category.
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