Key result
Higher GRACE risk scores, lack of revascularization, and lack of guideline-directed medical therapy were independent predictors of in-hospital mortality (overall 7.2%; P<0.05 each).
Why the study?
Clinical characteristics, management strategies, and in-hospital outcomes among high-risk patients with non-ST elevation myocardial infarction needed to be assessed.
Cross-Sectional (n=817)
No
p-value: p=<0.05
High-risk NSTEMI patients paradoxically receive less guideline-directed medical therapy and revascularization, which independently predicts higher in-hospital mortality.
OBJECTIVE: To assess clinical characteristics, management strategies and in-hospital outcome among high-risk patients of non-ST elevation myocardial infarction. METHODS: The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2016 of adult non-ST elevation myocardial infarction patients who had first cardiac event having Global Registry of Acute Coronary Eventsrisk score>140. Subcategories were formed on the basis of score range 140-159, 160-189 and ?190.Stata 12.1 was used for data analysis. RESULTS: Of the 817 patients, 567(69.4%) were men. Overall, mean age was 66.3}9.3 years. Coronary angiography was performed in 692(84.4%). With higher risk score categories, there was less frequent use of guideline directed medical therapy, coronary angiography and percutaneous or surgical revascularisation (p<0.05 each). Overall mortality was 59(7.2%). Mortality rates increased with increase in risk score subcategory (p<0.05). Multivariable model identified higher risk score category, no revascularisation and lack of guideline directed medical therapy as significant independent predictors of mortality (p<0.05 each). CONCLUSIONS: Mortality increased with higher risk score category. Paradoxically, high-risk patients were less likely to receive guideline directed medical therapy, to undergo coronary angiography and revascularisation, possibly suggesting a risk aversion approach by the treating physicians.
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Akhter et al. (2019) conducted a cross-sectional in Non-ST elevation myocardial infarction (NSTEMI) with high GRACE risk score (n=817). Higher GRACE risk score category vs. Lower GRACE risk score category was evaluated on In-hospital mortality (p=<0.05). Higher GRACE risk scores, lack of revascularization, and lack of guideline-directed medical therapy were independent predictors of in-hospital mortality (overall 7.2%; P<0.05 each).
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