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    Risk-Prediction Model for Ischemic Stroke in Patients Hospitalized With an Acute Coronary Syndrome (from the Global Registry of Acute Coronary Events [GRACE])

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    Authors
    Park, Kay Lee
    Budaj, Andrzej
    Goldberg, Robert J.
    Anderson, Frederick A. Jr.
    Agnelli, Giancarlo
    Kennelly, Brian M.
    Gurfinkel, Enrique P.
    Fitzgerald, Gordon
    Gore, Joel M.
    GRACE Investigators
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Department of Surgery
    Department of Medicine, Division of Cardiovascular Medicine
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2012-09-01
    Keywords
    Acute Coronary Syndrome
    Stroke
    Cardiovascular Diseases
    Health Services Research
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.amjcard.2012.04.040
    Abstract
    The risk of stroke in patients hospitalized with an acute coronary syndrome (ACS) ranges from <1% to ≥2.5%. The aim of this study was to develop a simple predictive tool for bedside risk estimation of in-hospital ischemic stroke in patients with ACS to help guide clinicians in the acute management of these high-risk patients. Data were obtained from 63,118 patients enrolled from April 1999 to December 2007 in the Global Registry of Acute Coronary Events (GRACE), a multinational registry involving 126 hospitals in 14 countries. A regression model was developed to predict the occurrence of in-hospital ischemic stroke in patients hospitalized with an ACS. The main study outcome was the development of ischemic stroke during the index hospitalization for an ACS. Eight risk factors for stroke were identified: older age, atrial fibrillation on index electrocardiogram, positive initial cardiac biomarkers, presenting systolic blood pressure ≥160 mm Hg, ST-segment change on index electrocardiogram, no history of smoking, higher Killip class, and lower body weight (c-statistic 0.7). The addition of coronary artery bypass graft surgery and percutaneous coronary intervention into the model increased the prediction of stroke risk. In conclusion, the GRACE stroke risk score is a simple tool for predicting in-hospital ischemic stroke risk in patients admitted for the entire spectrum of ACS, which is widely applicable to patients in various hospital settings and will assist in the management of high-risk patients with ACS. Copyright © 2012 Elsevier Inc. All rights reserved.
    Source
    Am J Cardiol. 2012 Sep 1;110(5):628-35. Epub 2012 May 19. DOI:10.1016/j.amjcard.2012.04.040
    DOI
    10.1016/j.amjcard.2012.04.040
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27174
    PubMed ID
    22608950
    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.amjcard.2012.04.040
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