Time course of events in acute coronary syndromes: implications for clinical practice from the GRACE registry
Time course of events in acute coronary syndromes: implications for clinical practice from the GRACE registry
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DOI：
10.1038/ncpcardio1302
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发表时间：
2008-09-01
期刊：
影响因子：
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通讯作者：
Gore, Joel M.
中科院分区：
文献类型：
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作者：
Fox, Keith A. A.;Anderson, Frederick A., Jr.;Gore, Joel M.
急性冠状动脉综合征后事件的时间进程可能影响治疗干预的时机和持续时间。我们研究了风险状态和ST段分类的影响presentation.Methods的死亡，再梗死，中风和大出血的时间在6个月内的急性冠状动脉综合征的46，829例患者在全球注册的急性冠状动脉事件（GRACE）。急性冠状动脉综合征按ST段抬高（n = 17，668）、抑郁（n = 8，542）或两者均不存在（n = 20，619）进行分类。确定三个时间段的GRACE风险评分和风险比（HR）：结果ST段抬高与早期死亡的相关性高于ST段压低（0-4天，HR 1.89，95% CI 1.60-2.24; 5-15天，HR 1.26，95% CI 1.05-1.50），但15天后风险逆转（16-180天，HR 0.85，95% CI 0.75-0.97）。在整个研究中，ST段偏移的患者比没有ST段偏移的患者有更高的死亡风险。在每个ST类别中，最高GRACE风险评分与最低评分相比，死亡风险高10-40倍（所有类别P < 0.0001）。结论急性冠状动脉综合征（ACS）后事件发生的时间受ST段抬高、ST段压低和非ST段抬高的影响，并受各心电图类型GRACE危险评分的影响。因此，风险分层应包括多种风险因素，而不是单独的ST段偏移。
Background The time course of events after acute coronary syndromes might influence the timing and duration of therapeutic interventions. We investigated the impact of risk status and ST-segment category at presentation.methods The timing of death, reinfarction, stroke and major bleeding within 6 months of acute coronary syndromes was determined in 46,829 patients enrolled in the Global Registry of Acute Coronary Events (GRACE). Acute coronary syndromes were classified by elevation (n = 17,668), depression (n = 8,542), or neither (n = 20,619) in the ST segment. GRACE risk scores and hazard ratios (HR) were determined for three time periods: 0-4,5-15 and 16-180 days.Results ST-segment elevation was associated with a higher early risk of death than was ST-segment depression (0-4 days, HR 1.89,95% Cl 1.60-2.24 versus 5-15 days, HR 1.26,95% Cl 1.05-1.50), but after 15 days the risk was reversed (16-180 days, H R 0.85,95% Cl 0.75-0.97). Throughout the study, patients with ST-segment deviation had a higher mortality risk than those without. Within each ST category, the highest GRACE risk scores were associated with a 10-40-fold greater risk of death than the lowest scores (all categories P < 0.0001). Most deaths Occurred after day 4 (57%,74%, and 78% for ST-segment elevation, depression and neither, respectively).Conclusion The timing of events after acute coronary syndromes was affected by ST category and influenced by GRACE risk score within each electrocardiographic category of acute coronary syndromes. Risk stratification should, therefore, include multiple risk factors rather than ST shift alone.