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dc.contributor.authorBajaj, Ravi R.
dc.contributor.authorGoodman, Shaun G.
dc.contributor.authorYan, Raymond T.
dc.contributor.authorBagnall, Alan J.
dc.contributor.authorGyenes, Gabor
dc.contributor.authorWelsh, Robert C.
dc.contributor.authorEagle, Kim A.
dc.contributor.authorBrieger, David
dc.contributor.authorRamanathan, Krishnan
dc.contributor.authorGrondin, Francois R.
dc.contributor.authorYan, Andrew T.
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:43:49Z
dc.date.available2022-08-23T15:43:49Z
dc.date.issued2013-01-15
dc.date.submitted2013-10-16
dc.identifier.citationBajaj RR, Goodman SG, Yan RT, Bagnall AJ, Gyenes G, Welsh RC, Eagle KA, Brieger D, Ramanathan K, Grondin FR, Yan AT; Canadian GRACE and CANRACE Investigators. Treatment and outcomes of patients with suspected acute coronary syndromes in relation to initial diagnostic impressions (insights from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE]). Am J Cardiol. 2013 Jan 15;111(2):202-7. doi: 10.1016/j.amjcard.2012.09.018. <a href="http://dx.doi.org/10.1016/j.amjcard.2012.09.018">Link to article on publisher's site</a>
dc.identifier.issn0002-9149 (Linking)
dc.identifier.doi10.1016/j.amjcard.2012.09.018
dc.identifier.pmid23122889
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27181
dc.description.abstractThe early diagnosis of acute coronary syndrome (ACS) remains challenging, and a considerable proportion of patients are diagnosed with "possible" ACS on admission. The Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 16,618 Canadian patients with suspected ACS in 1999 to 2008. We compared the demographic and clinical characteristics, use of cardiac procedures, prognostic accuracy of the GRACE risk score, and in-hospital outcomes between patients given an admission diagnosis of "definite" versus "possible" ACS by the treating physician. Overall, 11,152 and 5,466 patients were given an initial diagnosis of "definite" ACS and "possible" ACS, respectively. Patients with a "possible" ACS had higher GRACE risk score (median 130 vs 125) and less frequently received aspirin, clopidogrel, heparin, or beta blockers within the first 24 hours of presentation and assessment of left ventricular function, stress testing, cardiac catheterization, and percutaneous coronary intervention (all p <0.05). Patients with "possible" ACS had greater rates of in-hospital myocardial infarction (9.0% vs 2.0%, p <0.05) and heart failure (12% vs 8.9%, p <0.05). The GRACE risk score demonstrated excellent discrimination for in-hospital mortality in both groups and for the entire study population. In conclusion, compared to patients with "definite" ACS on presentation, those with "possible" ACS had higher baseline GRACE risk scores but less frequently received evidence-based medical therapies within 24 hours of admission or underwent cardiac procedures during hospitalization. The GRACE risk score provided accurate risk assessment, regardless of the initial diagnostic impression.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=23122889&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.amjcard.2012.09.018
dc.subjectAcute Coronary Syndrome
dc.subjectAged
dc.subjectCanada
dc.subject*Electrocardiography
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subject*Percutaneous Coronary Intervention
dc.subjectPredictive Value of Tests
dc.subjectPrognosis
dc.subjectProspective Studies
dc.subject*Registries
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectSurvival Rate
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.subjectHealth Services Research
dc.titleTreatment and outcomes of patients with suspected acute coronary syndromes in relation to initial diagnostic impressions (insights from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE])
dc.typeJournal Article
dc.source.journaltitleThe American journal of cardiology
dc.source.volume111
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/110
dc.identifier.contextkey4728667
html.description.abstract<p>The early diagnosis of acute coronary syndrome (ACS) remains challenging, and a considerable proportion of patients are diagnosed with "possible" ACS on admission. The Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 16,618 Canadian patients with suspected ACS in 1999 to 2008. We compared the demographic and clinical characteristics, use of cardiac procedures, prognostic accuracy of the GRACE risk score, and in-hospital outcomes between patients given an admission diagnosis of "definite" versus "possible" ACS by the treating physician. Overall, 11,152 and 5,466 patients were given an initial diagnosis of "definite" ACS and "possible" ACS, respectively. Patients with a "possible" ACS had higher GRACE risk score (median 130 vs 125) and less frequently received aspirin, clopidogrel, heparin, or beta blockers within the first 24 hours of presentation and assessment of left ventricular function, stress testing, cardiac catheterization, and percutaneous coronary intervention (all p <0.05). Patients with "possible" ACS had greater rates of in-hospital myocardial infarction (9.0% vs 2.0%, p <0.05) and heart failure (12% vs 8.9%, p <0.05). The GRACE risk score demonstrated excellent discrimination for in-hospital mortality in both groups and for the entire study population. In conclusion, compared to patients with "definite" ACS on presentation, those with "possible" ACS had higher baseline GRACE risk scores but less frequently received evidence-based medical therapies within 24 hours of admission or underwent cardiac procedures during hospitalization. The GRACE risk score provided accurate risk assessment, regardless of the initial diagnostic impression.</p>
dc.identifier.submissionpathcor_grace/110
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages202-7


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