GRACE Publicationshttp://hdl.handle.net/20.500.14038/1132024-03-28T19:57:08Z2024-03-28T19:57:08ZPerformance of the GRACE Risk Score 2.0 Simplified Algorithm for Predicting 1-Year Death After Hospitalization for an Acute Coronary Syndrome in a Contemporary Multiracial CohortHuang, WeiFitzGerald, GordonGoldberg, Robert J.Gore, Joel M.McManus, Richard H.Awad, Hamza H.Waring, Molly E.Allison, Jeroan J.Saczynski, Jane S.Kiefe, Catarina I.Fox, Keith A. A.Anderson, Frederick A. Jr.McManus, David D.TRACE-CORE Investigatorshttp://hdl.handle.net/20.500.14038/271972022-12-29T14:24:17Z2016-10-15T00:00:00ZPerformance of the GRACE Risk Score 2.0 Simplified Algorithm for Predicting 1-Year Death After Hospitalization for an Acute Coronary Syndrome in a Contemporary Multiracial Cohort
Huang, Wei; FitzGerald, Gordon; Goldberg, Robert J.; Gore, Joel M.; McManus, Richard H.; Awad, Hamza H.; Waring, Molly E.; Allison, Jeroan J.; Saczynski, Jane S.; Kiefe, Catarina I.; Fox, Keith A. A.; Anderson, Frederick A. Jr.; McManus, David D.; TRACE-CORE Investigators
The GRACE Risk Score is a well-validated tool for estimating short- and long-term risk in acute coronary syndrome (ACS). GRACE Risk Score 2.0 substitutes several variables that may be unavailable to clinicians and, thus, limit use of the GRACE Risk Score. GRACE Risk Score 2.0 performed well in the original GRACE cohort. We sought to validate its performance in a contemporary multiracial ACS cohort, in particular in black patients with ACS. We evaluated the performance of the GRACE Risk Score 2.0 simplified algorithm for predicting 1-year mortality in 2,131 participants in Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE), a multiracial cohort of patients discharged alive after an ACS in 2011 to 2013 from 6 hospitals in Massachusetts and Georgia. The median age of study participants was 61 years, 67% were men, and 16% were black. Half (51%) of the patients experienced a non-ST-segment elevation myocardial infarction (NSTEMI) and 18% STEMI. Eighty patients (3.8%) died within 12 months of discharge. The GRACE Risk Score 2.0 simplified algorithm demonstrated excellent model discrimination for predicting 1-year mortality after hospital discharge in the TRACE-CORE cohort (c-index = 0.77). The c-index was 0.94 in patients with STEMI, 0.78 in those with NSTEMI, and 0.87 in black patients with ACS. In conclusion, the GRACE Risk Score 2.0 simplified algorithm for predicting 1-year mortality exhibited excellent model discrimination across the spectrum of ACS types and racial/ethnic subgroups and, thus, may be a helpful tool to guide routine clinical care for patients with ACS.
2016-10-15T00:00:00ZTemporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary EventsArbel, YaronFitzGerald, GordonYan, Andrew T.Tan, Mary K.Fox, Keith A. A.Gore, Joel M.Steg, Phillippe GabrielEagle, Kim A.Brieger, DavidMontalescot, GillesBudaj, AndrzejLopez-Sendon, JoseAvezum, AlvaroGranger, Christopher B.Goodman, Shaun G.http://hdl.handle.net/20.500.14038/271942022-12-29T14:24:17Z2016-09-01T00:00:00ZTemporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary Events
Arbel, Yaron; FitzGerald, Gordon; Yan, Andrew T.; Tan, Mary K.; Fox, Keith A. A.; Gore, Joel M.; Steg, Phillippe Gabriel; Eagle, Kim A.; Brieger, David; Montalescot, Gilles; Budaj, Andrzej; Lopez-Sendon, Jose; Avezum, Alvaro; Granger, Christopher B.; Goodman, Shaun G.
Objective Smoking has been shown to be a risk factor for heart disease. However, it was recently reported that despite the evolution in therapy for acute coronary syndrome (ACS), smokers have not demonstrated improved outcomes. The aim of the present study was to evaluate the temporal trends in the treatments and outcomes across a broad spectrum of ACS patients (STEMI and non-ST-elevation ACS [NSTEACS]) according to smoking status on presentation in the Global Registry of Acute Coronary Events (GRACE). Methods Our cohort was stratified into 3 groups: current smokers, former smokers and never smokers. We evaluated trends in demographics, treatment modalities and outcomes in these 3 groups from 1999 to 2007. Results The study population comprised a total of 63,015 patients admitted to hospital with an ACS and with identifiable baseline smoking status. Smokers presented with STEMI more often than non-smokers. There was an unadjusted decline in 30-day mortality in all 3 groups. However, the adjusted decline was not statistically significant among current smokers (HR = 0.98 per study year, 95% CI 0.94–1.01, p = 0.20). A subgroup analysis of 22,894 STEMI patients demonstrated no reduction in annual adjusted 30-day mortality rates among smokers (HR = 1.01, 95% CI 0.96–1.06 (Table 5), whereas former and never smokers' mortality declined. Conclusions Over the years 1999–2007, 30-day mortality declined in patients presenting with acute coronary syndrome. However, smokers presenting with STEMI did not demonstrate a reduction in mortality.
2016-09-01T00:00:00ZPrognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndromeSarak, BradleyGoodman, Shaun G.Yan, Raymond T.Tan, Mary K.Steg, Phillippe GabrielTan, Nigel S.Fox, Keith A. A.Udell, Jacob A.Brieger, DavidWelsh, Robert C.Gale, Chris P.Yan, Andrew T.Canadian Acute Coronary Syndromes IGlobal Registry of Acute Coronary Events (GRACE) Investigatorshttp://hdl.handle.net/20.500.14038/271962022-12-29T14:24:17Z2016-09-01T00:00:00ZPrognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome
Sarak, Bradley; Goodman, Shaun G.; Yan, Raymond T.; Tan, Mary K.; Steg, Phillippe Gabriel; Tan, Nigel S.; Fox, Keith A. A.; Udell, Jacob A.; Brieger, David; Welsh, Robert C.; Gale, Chris P.; Yan, Andrew T.; Canadian Acute Coronary Syndromes I; Global Registry of Acute Coronary Events (GRACE) Investigators
OBJECTIVE: To assess the relationship between the evolution of T wave inversion (TWI) on the 24-48 h postadmission ECG and the patient characteristics, management and clinical outcomes among those with non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS: We evaluated admission and 24-48 h follow-up ECGs of 7201 patients with NSTE-ACS from the prospective, multicentre Global Registry of Acute Coronary Events (GRACE) and Canadian ACS Registry I. We performed multivariable analyses to determine the association between new TWI (on follow-up ECG only), resolved TWI (on admission ECG only) and persistent TWI (on both admission and follow-up ECG) and inhospital and cumulative 6-month all-cause mortality. RESULTS: Patients with TWI were older, more likely to have cardiovascular risk factors, higher Killip class and GRACE risk scores. After adjustment for known prognostic factors, compared with patients presenting without TWI, new TWI was associated with significantly lower inhospital mortality (OR=0.60, 95% CI 0.38 to 0.95, p=0.029), whereas resolved (OR=1.06, 95% CI 0.65 to 1.75, p=0.81) and persistent (OR=0.73, 95% CI 0.48 to 1.11, p=0.14) TWI did not predict inhospital mortality. No TWI pattern independently predicted inhospital adverse cardiovascular events or cumulative 6-month mortality. In contrast, ST depression on the admission and follow-up ECG were independent predictors of inhospital and 6-month mortality. CONCLUSIONS: Across the spectrum of NSTE-ACS, TWI within 48 h of presentation was associated with high-risk clinical features, but its presence or dynamic change did not provide additional prognostic value beyond other established clinical predictors.
2016-09-01T00:00:00ZClinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on PresentationChan, William K.Goodman, Shaun G.Brieger, DavidFox, Keith A. A.Gale, Chris P.Chew, Derek P.Udell, Jacob A.Lopez-Sendon, JoseHuynh, ThaoYan, Raymond T.Singh, Sheldon M.Yan, Andrew T.ACS I and GRACE Investigatorshttp://hdl.handle.net/20.500.14038/271952022-12-29T14:31:49Z2016-03-01T00:00:00ZClinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on Presentation
Chan, William K.; Goodman, Shaun G.; Brieger, David; Fox, Keith A. A.; Gale, Chris P.; Chew, Derek P.; Udell, Jacob A.; Lopez-Sendon, Jose; Huynh, Thao; Yan, Raymond T.; Singh, Sheldon M.; Yan, Andrew T.; ACS I and GRACE Investigators
We examined the relations between right bundle branch block (RBBB) and clinical characteristics, management, and outcomes among a broad spectrum of patients with acute coronary syndrome (ACS). Admission electrocardiograms of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) electrocardiogram substudy and the Canadian ACS Registry I were analyzed independently at a blinded core laboratory. We performed multivariable logistic regression analysis to assess the independent prognostic significance of admission RBBB on in-hospital and 6-month mortality. Of 11,830 eligible patients with ACS (mean age 65; 66% non-ST-elevation ACS), 5% had RBBB. RBBB on admission was associated with older age, male sex, more cardiovascular risk factors, worse Killip class, and higher GRACE risk score (all p < 0.01). Patients with RBBB less frequently received in-hospital cardiac catheterization, coronary revascularization, or reperfusion therapy (all p < 0.05). The RBBB group had higher unadjusted in-hospital (8.8% vs 3.8%, p < 0.001) and 6-month mortality rates (15.1% vs 7.6%, p < 0.001). After adjusting for established prognostic factors in the GRACE risk score, RBBB was a significant independent predictor of in-hospital death (odds ratio 1.45, 95% CI 1.02 to 2.07, p = 0.039), but not cumulative 6-month mortality (odds ratio 1.29, 95% CI 0.95 to 1.74, p = 0.098). There was no significant interaction between RBBB and the type of ACS for either in-hospital or 6-month mortality (both p > 0.50). In conclusion, across a spectrum of ACS, RBBB was associated with preexisting cardiovascular disease, high-risk clinical features, fewer cardiac interventions, and worse unadjusted outcomes. After adjusting for components of the GRACE risk score, RBBB was a significant independent predictor of early mortality.
2016-03-01T00:00:00ZCardiovascular Risk Factors and In-Hospital Mortality in Acute Coronary Syndromes: Insights From the Canadian Global Registry of Acute Coronary EventsWang, Jenny Y.Goodman, Shaun G.Saltzman, IlanaWong, Graham C.Huynh, ThaoDery, Jean-PierreLeiter, Lawrence A.Bhatt, DeepakWelsh, Robert C.Spencer, Frederick A.Fox, Keith A. A.Yan, Andrew T.Global Registry of Acute Coronary Events (GRACE/GRACE-2)Canadian Registry of Acute Coronary Events (CANRACE) Investigatorshttp://hdl.handle.net/20.500.14038/271932022-12-29T15:00:08Z2015-04-17T00:00:00ZCardiovascular Risk Factors and In-Hospital Mortality in Acute Coronary Syndromes: Insights From the Canadian Global Registry of Acute Coronary Events
Wang, Jenny Y.; Goodman, Shaun G.; Saltzman, Ilana; Wong, Graham C.; Huynh, Thao; Dery, Jean-Pierre; Leiter, Lawrence A.; Bhatt, Deepak; Welsh, Robert C.; Spencer, Frederick A.; Fox, Keith A. A.; Yan, Andrew T.; Global Registry of Acute Coronary Events (GRACE/GRACE-2); Canadian Registry of Acute Coronary Events (CANRACE) Investigators
BACKGROUND: There are conflicting data regarding the relationship between the number of modifiable traditional risk factors and prognosis in acute coronary syndromes (ACS). This controversy might in part be explained by the differential use of prehospital medications. METHODS: Using data from the Canadian, multicentre Global Registry of Acute Coronary Events (GRACE) (1999-2008), we stratified 13,686 ACS patients into 3 groups (0, 1-2, vs 3-4 risk factors) and compared their baseline characteristics, in-hospital treatments, and outcomes. Multivariable logistic regressions were performed to adjust for the components of the GRACE risk score and preadmission statin and acetylsalicylic acid (ASA) use. RESULTS: Among these patients (ST-elevation myocardial infarction 28.3%), 14.5%, 62.6%, and 22.9% had 0, 1-2, and 3-4 risk factors, respectively. Patients with fewer risk factors were less likely to be on ASA, statin, and other prehospital medications. Unadjusted in-hospital mortality was significantly different across risk factor groups (4.9%, 3.0%, and 3.1% for 0, 1-2, and 3-4 risk factor groups, respectively, P for trend = 0.002). This difference was no longer significant after adjusting for the components of the GRACE risk score (P for trend = 0.088) and further adjusting for preadmission statin and ASA use (P for trend = 0.96). For in-hospital mortality, there was no significant interaction between risk factor categories and ACS type (P = 0.26). CONCLUSIONS: The lower mortality observed in patients with ACS with more risk factors may be partially attributed to the protective effect of prehospital ASA and statin use. The number of risk factors does not provide incremental prognostic value beyond the validated GRACE risk score.
2015-04-17T00:00:00ZIn-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failureZhang, HanfeiGoodman, Shaun G.Yan, Raymond T.Steg, Phillippe GabrielKornder, Jan M.Gyenes, GaborGrondin, Francois R.Brieger, DavidDeYoung, J. PaulGallo, RichardYan, Andrew T.http://hdl.handle.net/20.500.14038/271922022-12-29T15:00:08Z2015-03-12T00:00:00ZIn-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failure
Zhang, Hanfei; Goodman, Shaun G.; Yan, Raymond T.; Steg, Phillippe Gabriel; Kornder, Jan M.; Gyenes, Gabor; Grondin, Francois R.; Brieger, David; DeYoung, J. Paul; Gallo, Richard; Yan, Andrew T.
INTRODUCTION: The prognostic significance of prior heart failure in acute coronary syndromes has not been well studied. Accordingly, we evaluated the baseline characteristics, management patterns and clinical outcomes in patients with acute coronary syndromes who had prior heart failure. METHODS AND RESULTS: The study population consisted of acute coronary syndrome patients in the Global Registry of Acute Coronary Events, expanded Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events between 1999 and 2008. Of the 13,937 eligible patients (mean age 66±13 years, 33% female and 28.3% with ST-elevation myocardial infarction), 1498 (10.7%) patients had a history of heart failure. Those with prior heart failure tended to be older, female and had lower systolic blood pressure, higher Killip class and creatinine on presentation. Prior heart failure was also associated with significantly worse left ventricular systolic function and lower rates of cardiac catheterization and coronary revascularization. The group with previous heart failure had significantly higher rates of acute decompensated heart failure, cardiogenic shock, myocardial (re)infarction and mortality in hospital. In multivariable analysis, prior heart failure remained an independent predictor of in-hospital mortality (odds ratio 1.48, 95% confidence interval 1.08-2.03, p=0.015). CONCLUSIONS: Prior heart failure was associated with high risk features on presentation and adverse outcomes including higher adjusted in-hospital mortality in acute coronary syndrome patients. However, acute coronary syndrome patients with prior heart failure were less likely to receive evidence-based therapies, suggesting potential opportunities to target more intensive treatment to improve their outcome.
2015-03-12T00:00:00ZHigh-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary EventsSingh, Sheldon M.FitzGerald, GordonYan, Andrew T.Brieger, DavidFox, Keith A. A.Lopez-Sendon, JoseYan, Raymond T.Eagle, Kim A.Steg, Phillippe GabrielBudaj, AndrzejGoodman, Shaun G.http://hdl.handle.net/20.500.14038/271902022-12-29T15:00:08Z2014-09-08T00:00:00ZHigh-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events
Singh, Sheldon M.; FitzGerald, Gordon; Yan, Andrew T.; Brieger, David; Fox, Keith A. A.; Lopez-Sendon, Jose; Yan, Raymond T.; Eagle, Kim A.; Steg, Phillippe Gabriel; Budaj, Andrzej; Goodman, Shaun G.
BACKGROUND: While prior work has suggested that a high-grade atrioventricular block (HAVB) in the setting of an acute coronary syndrome (ACS) is associated with in-hospital death, limited information is available on the incidence of, and death associated with, HAVB in ACS patients receiving contemporary management. METHODS AND RESULTS: The incidence of HAVB was determined within The Global Registry of Acute Coronary Events (GRACE). The clinical characteristics, in-hospital therapies, and outcomes were compared between patients with and without HAVB. Factors associated with death in patients with HAVB were determined. A total of 59 229 patients with ACS between 1999 and 2007 were identified; 2.9% of patients had HAVB at any point during the index hospitalization; 22.7% of whom died in hospital [adjusted odds ratio (OR) = 4.2, 95% confidence interval (CI), 3.6-4.9, P < 0.001]. The association between HAVB and in-hospital death varied with type of ACS [OR: ST-segment elevation myocardial infarction (STEMI) = 3.0; non-STEMI = 6.4; unstable angina = 8.2, P for interaction < 0.001]. High-grade atrioventricular block present at the time of presentation to hospital (vs. occurring in-hospital) and early (12 h or no intervention) were associated with improved in-hospital survival, whereas temporary pacemaker insertion was not. Patients with HAVB surviving to discharge had similar adjusted survival at 6 months compared with those without HAVB. A reduction in the rate of, but not in-hospital mortality associated with, HAVB was noted over the study period. CONCLUSION: Although the incidence of HAVB is low and decreasing, this complication continues to have a high risk of in-hospital death.
2014-09-08T00:00:00ZGRACE score predicts heart failure admission following acute coronary syndromeMcAllister, David A.Halbesma, NynkeCarruthers, Kathryn F.Denvir, MartinFox, Keith A.http://hdl.handle.net/20.500.14038/271882022-12-29T15:00:08Z2014-07-01T00:00:00ZGRACE score predicts heart failure admission following acute coronary syndrome
McAllister, David A.; Halbesma, Nynke; Carruthers, Kathryn F.; Denvir, Martin; Fox, Keith A.
BACKGROUND: Congestive heart failure (CHF) is a common and preventable complication of acute coronary syndrome (ACS). Nevertheless, ACS risk scores have not been shown to predict CHF risk. We investigated whether the at-discharge Global Registry of Acute Coronary Events (GRACE) score predicts heart failure admission following ACS. METHODS AND RESULTS: Five-year mortality and hospitalization data were obtained for patients admitted with ACS from June 1999 to September 2009 to a single centre of the GRACE registry. CHF was defined as any admission assigned WHO International Classification of Diseases 10 diagnostic code I50. The hazard ratio (HR) for CHF according to GRACE score was estimated in Cox models adjusting for age, gender and the presence of CHF on index admission. Among 1,956 patients, CHF was recorded on index admission in 141 patients (7%), and 243 (12%) were admitted with CHF over 3.8 median years of follow-up. Compared to the lowest quintile, patients in the highest GRACE score quintile had more CHF admissions (116 vs 17) and a shorter time to first admission (1.2 vs 2.0 years, HR 9.87, 95% CI 5.93-16.43). Per standard deviation increment in GRACE score, the instantaneous risk was more than two-fold higher (HR 2.28; 95% CI 2.02-2.57), including after adjustment for CHF on index admission, age and gender (HR 2.49; 95% CI 2.06-3.02). The C-statistic for CHF admission at 1-year was 0.74 (95% CI 0.70-0.79). CONCLUSIONS: The GRACE score predicts CHF admission, and may therefore be used to target ACS patients at high risk of CHF with clinical monitoring and therapies.
2014-07-01T00:00:00ZBeta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE)Lee Park, KayGoldberg, Robert J.Anderson, Frederick A. Jr.Lopez-Sendon, JoseMontalescot, GillesBrieger, DavidEagle, Kim A.Wyman, AllisonGore, Joel M.GRACE Investigatorshttp://hdl.handle.net/20.500.14038/271872022-12-29T15:00:08Z2014-06-01T00:00:00ZBeta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE)
Lee Park, Kay; Goldberg, Robert J.; Anderson, Frederick A. Jr.; Lopez-Sendon, Jose; Montalescot, Gilles; Brieger, David; Eagle, Kim A.; Wyman, Allison; Gore, Joel M.; GRACE Investigators
BACKGROUND: Current guidelines recommend early oral beta-blocker administration in the management of acute coronary syndromes for patients who are not at high risk of complications. METHODS: Data from patients enrolled between 2000 and 2007 in the Global Registry of Acute Coronary Events (GRACE) were used to evaluate hospital outcomes in three cohorts of patients admitted with ST-elevation myocardial infarction, based on beta-blocker use (early [first 24 hours] intravenous [± oral], only early oral, or delayed [after first 24 hours]). RESULTS: Among 13,110 patients with a ST-elevation myocardial infarction, 21% received any early intravenous beta-blockers, 65% received only early oral beta-blockers, and 14% received delayed (>24 hours) beta-blockers. Higher systolic blood pressure, higher heart rate, and chronic beta-blocker use were independent predictors of early beta-blocker use. Early beta-blocker use was less likely in older patients, patients with moderate to severe left ventricular dysfunction, and in those presenting with inferior myocardial infarction or Killip class III heart failure. Intravenous beta-blocker use and delayed beta-blocker use were associated with higher rates of cardiogenic shock, sustained ventricular fibrillation/ventricular tachycardia and acute heart failure, compared with oral beta-blocker use. In-hospital mortality was increased with IV beta-blocker use (propensity score adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.03-1.92) but significantly reduced with delayed beta-blocker administration (propensity adjusted OR, 0.44; 95% CI, 0.26-0.74). CONCLUSIONS: Early beta-blocker use is common in patients presenting with ST-elevation myocardial infarction, with oral administration being most prevalent. Oral beta-blockers were associated with a decrease in the risk of cardiogenic shock, ventricular arrhythmias, and acute heart failure. However, the early receipt of any form of beta-blockers was associated with an increase in hospital mortality.
2014-06-01T00:00:00ZClinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblockZhang, HanfeiGoodman, Shaun G.Steg, Gabriel P.Budaj, AndrzejLopez-Sendon, JoseDorian, PaulHuynh, ThaoMangat, IqwalWong, Graham C.Spencer, Frederick A.Yan, Andrew T.Global Registry of Acute Coronary Events (GRACE) ECG Substudy Investigators and the Canadian ACS Registry Investigatorshttp://hdl.handle.net/20.500.14038/271892022-12-29T15:00:08Z2014-05-19T00:00:00ZClinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock
Zhang, Hanfei; Goodman, Shaun G.; Steg, Gabriel P.; Budaj, Andrzej; Lopez-Sendon, Jose; Dorian, Paul; Huynh, Thao; Mangat, Iqwal; Wong, Graham C.; Spencer, Frederick A.; Yan, Andrew T.; Global Registry of Acute Coronary Events (GRACE) ECG Substudy Investigators and the Canadian ACS Registry Investigators
OBJECTIVE: We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS). METHODS: Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality. RESULTS: Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all p<0.01). Patients with LAHB less frequently underwent cardiac catheterisation, coronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99). CONCLUSIONS: Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models.
2014-05-19T00:00:00Z