Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up
Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up
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DOI：
10.1016/j.amjmed.2014.12.007
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发表时间：
2015-07-01
影响因子：
5.9
通讯作者：
Goodman, Shaun G.
中科院分区：
文献类型：
--
作者：
Alnasser, Sami M. A.;Huang, Wei;Goodman, Shaun G.
目得：急性冠状动脉综合征的短期结局已得到很好的描述;然而，对这些患者的长期随访，包括ST段抬高型心肌梗死、非ST段抬高型心肌梗死和不稳定型心绞痛，则更为有限。因此，我们描述了长期的结果，程序和药物的使用在全球急性冠状动脉事件登记处（GRACE）的医院幸存者进行6个月和2年的随访，并在预测2年mortality.METHODS：在1999年和2007年之间，70,395例疑似急性冠状动脉综合征患者入组。2004年，对57个地点的出院急性冠脉综合征诊断患者进行了为期2年的前瞻性随访。87.2%的患者接受了随访;出院后2年，14.3%接受了血管造影术，8.7%接受了经皮冠状动脉介入治疗，2.0%接受了冠状动脉搭桥手术，24.2%再次住院。在2年随访的患者中，使用了乙酰水杨酸（88.7%）、β受体阻滞剂（80.4%）、肾素-血管紧张素系统抑制剂（69.8%）和他汀类药物（80.2%）治疗。心力衰竭发生率为6.3%，（再）梗死发生率为4.4%，死亡发生率为7.1%。出院至6个月GRACE风险评分对2年全因死亡率具有高度预测性（c-统计量0.80）。结论：在急性冠脉综合征患者的大型多国队列中，存在重要的后期不良后果，包括频繁的发病率和死亡率。这些结果是在额外冠状动脉手术的背景下观察到的，尽管在高比例的患者中继续使用循证治疗。GRACE风险评分在医院幸存者中预测长期死亡率的判别准确性得以维持。(C)2015 Elsevier Inc. All rights reserved.
PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality.METHODS: Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites.RESULTS: From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), betablocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re) infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80).CONCLUSION: In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained. (C) 2015 Elsevier Inc. All rights reserved.