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    Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE)

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    Authors
    Steg, Phillippe Gabriel
    Dabbous, Omar H.
    Feldman, Laurent J.
    Cohen-Solal, Alain
    Aumont, Marie-Claude
    López-Sendón, José
    Budaj, Andrzej
    Goldberg, Robert J.
    Klein, Werner
    Anderson, Frederick A.
    UMass Chan Affiliations
    Department of Surgery
    Department of Medicine, Division of Cardiovascular Medicine
    Document Type
    Journal Article
    Publication Date
    2004-01-28
    Keywords
    Acute Disease
    Aged
    Angina, Unstable
    Female
    Heart Failure
    Hospital Mortality
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Prognosis
    Prospective Studies
    Registries
    Syndrome
    Time Factors
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1161/01.CIR.0000109691.16944.DA
    Abstract
    BACKGROUND: Few data are available on the impact of heart failure (HF) across all types of acute coronary syndromes (ACS). METHODS AND RESULTS: The Global Registry of Acute Coronary Events (GRACE) is a prospective study of patients hospitalized with ACS. Data from 16 166 patients were analyzed: 13 707 patients without prior HF or cardiogenic shock at presentation were identified. Of these, 1778 (13%) had an admission diagnosis of HF (Killip class II or III). HF on admission was associated with a marked increase in mortality rates during hospitalization (12.0% versus 2.9% [with versus without HF], P<0.0001) and at 6 months after discharge (8.5% versus 2.8%, P<0.0001). Of note, HF increased mortality rates in patients with unstable angina (defined as ACS with normal biochemical markers of necrosis; mortality rates: 6.7% with versus 1.6% without HF at admission, P<0.0001). By logistic regression analysis, admission HF was an independent predictor of hospital death (odds ratio, 2.2; P<0.0001). Admission HF was associated with longer hospital stay and higher readmission rates. Patients with HF had lower rates of catheterization and percutaneous cardiac intervention, and fewer received beta-blockers and statins. Hospital development of HF (versus HF on presentation) was associated with an even higher in-hospital mortality rate (17.8% versus 12.0%, P<0.0001). In patients with HF, in-hospital revascularization was associated with lower 6-month death rates (14.0% versus 23.7%, P<0.0001; adjusted hazard ratio, 0.5; 95% CI, 0.37 to 0.68, P<0.0001). CONCLUSIONS: In this observational registry, heart failure was associated with reduced hospital and 6-month survival across all ACS subsets, including patients with normal markers of necrosis. More aggressive treatment of these patients may be warranted to improve prognosis.
    Source
    Circulation. 2004 Feb 3;109(4):494-9. Epub 2004 Jan 26. Link to article on publisher's site
    DOI
    10.1161/01.CIR.0000109691.16944.DA
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47178
    PubMed ID
    14744970
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1161/01.CIR.0000109691.16944.DA
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    Population and Quantitative Health Sciences Publications

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