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    Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score

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    BMJ_Open_2014_Fox_.pdf
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    Authors
    Fox, Keith A. A.
    FitzGerald, Gordon
    Puymirat, Etienne
    Huang, Wei
    Carruthers, Kathryn
    Simon, Tabassome
    Coste, Pierre
    Monsegu, Jacques
    Steg, Phillippe Gabriel
    Danchin, Nicolas
    Anderson, Frederick A. Jr.
    Show allShow less
    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2014-02-21
    Keywords
    Acute coronary syndromes
    Myocardical infarction
    Risk factors
    Risk management
    Risk scores
    Medical management
    Emergency medicine
    Cardiology
    Cardiovascular Diseases
    Health Services Research
    
    Metadata
    Show full item record
    Abstract
    OBJECTIVES: Risk scores are recommended in guidelines to facilitate the management of patients who present with acute coronary syndromes (ACS). Internationally, such scores are not systematically used because they are not easy to apply and some risk indicators are not available at first presentation. We aimed to derive and externally validate a more accurate version of the Global Registry of Acute Coronary Events (GRACE) risk score for predicting the risk of death or death/myocardial infarction (MI) both acutely and over the longer term. The risk score was designed to be suitable for acute and emergency clinical settings and usable in electronic devices. DESIGN AND SETTING: The GRACE risk score (2.0) was derived in 32 037 patients from the GRACE registry (14 countries, 94 hospitals) and validated externally in the French registry of Acute ST-elevation and non-ST-elevation MI (FAST-MI) 2005. PARTICIPANTS: Patients presenting with ST-elevation and non-ST elevation ACS and with long-term outcomes. OUTCOME MEASURES: The GRACE Score (2.0) predicts the risk of short-term and long-term mortality, and death/MI, overall and in hospital survivors. RESULTS: For key independent risk predictors of death (1 year), non-linear associations (vs linear) were found for age (p CONCLUSIONS: The updated GRACE risk score has better discrimination and is easier to use than the previous score based on linear associations. GRACE Risk (2.0) performed equally well acutely and over the longer term and can be used in a variety of clinical settings to aid management decisions.
    Source
    Fox KA, Fitzgerald G, Puymirat E, Huang W, Carruthers K, Simon T, Coste P, Monsegu J, Gabriel Steg P, Danchin N, Anderson F. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014 Feb 21;4(2):e004425. doi: 10.1136/bmjopen-2013-004425. Link to article on publisher's site
    DOI
    10.1136/bmjopen-2013-004425
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27186
    PubMed ID
    24561498
    Related Resources
    Link to article in PubMed
    Rights
    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:http://creativecommons.org/licenses/by-nc/3.0/
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2013-004425
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    GRACE Publications

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