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- W2028873082 abstract "Risk assessment is fundamental in the management of acute coronary syndromes (ACS), enabling estimation of prognosis. To evaluate whether the combined use of GRACE and CRUSADE risk stratification schemes in patients with myocardial infarction outperforms each of the scores individually in terms of mortality and haemorrhagic risk prediction. Observational retrospective single-centre cohort study including 566 consecutive patients admitted for non-ST-segment elevation myocardial infarction. The CRUSADE model increased GRACE discriminatory performance in predicting all-cause mortality, ascertained by Cox regression, demonstrating CRUSADE independent and additive predictive value, which was sustained throughout follow-up. The cohort was divided into four different subgroups: G1 (GRACE < 141; CRUSADE < 41); G2 (GRACE < 141; CRUSADE ≥ 41); G3 (GRACE ≥ 141; CRUSADE < 41); G4 (GRACE ≥ 141; CRUSADE ≥ 41). Outcomes and variables estimating clinical severity, such as admission Killip-Kimbal class and left ventricular systolic dysfunction, deteriorated progressively throughout the subgroups (G1 to G4). Survival analysis differentiated three risk strata (G1, lowest risk; G2 and G3, intermediate risk; G4, highest risk). The GRACE + CRUSADE model revealed higher prognostic performance (area under the curve [AUC] 0.76) than GRACE alone (AUC 0.70) for mortality prediction, further confirmed by the integrated discrimination improvement index. Moreover, GRACE + CRUSADE combined risk assessment seemed to be valuable in delineating bleeding risk in this setting, identifying G4 as a very high-risk subgroup (hazard ratio 3.5; P < 0.001). Combined risk stratification with GRACE and CRUSADE scores can improve the individual discriminatory power of GRACE and CRUSADE models in the prediction of all-cause mortality and bleeding. This combined assessment is a practical approach that is potentially advantageous in treatment decision-making. L’évaluation des risques est fondamentale dans la gestion des syndromes coronariens aigus, permettant l’estimation du pronostic. Le but de notre étude était d’évaluer l’utilisation combinée des scores GRACE et CRUSADE pour la stratification de la mortalité et du risque hémorragique des patients pris en charge pour un infarctus aigu du myocarde en comparaison à l’utilisation isolée de chacun de ces scores. Cohorte rétrospective observationnelle monocentrique ayant inclus 566 patients consécutifs hospitalisés pour un syndrome coronarien aigu sans sus-décalage du segment ST. Le score CRUSADE a augmenté le pouvoir discriminant du score GRACE pour la prédiction de la mortalité globale, en utilisant la régression de Cox, ce qui démontre la valeur prédictive indépendante et additive du score CRUSADE, laquelle était maintenue tout au long du suivi. La cohorte a été divisée en 4 sous-groupes : G1 (GRACE < 141 ; CRUSADE < 41) ; G2 (GRACE < 141 ; CRUSADE ≥ 41) ; G3 (GRACE ≥ 141 ; CRUSADE < 41) ; G4 (GRACE ≥ 141 ; CRUSADE ≥ 41). Les événements et variables qui évaluaient la sévérité clinique, comme la classe Killip-Kimbal à l’admission et la dysfonction systolique du ventricule gauche étaient plus fréquents de manière linéaire en fonction des sous-groupes (G1–G4). L’analyse de la survie a montré 3 groupes de risque (G1, risque bas ; G2 et G3, risque intermédiaire ; G4, risque plus élevé). Le modèle GRACE + CRUSADE a montré une performance pronostique supérieure (AUC 0,76) au score GRACE utilisé de manière isolé (AUC 0,70) pour la prédiction de la mortalité, ce qui a été confirmé par l’amélioration de l’index de la discrimination intégrée. De plus, l’évaluation combinée des scores GRACE + CRUSADE semble avoir une valeur additionnelle pour la prédiction de risque de saignement et permet d’identifier le groupe G4 comme étant à risque très élevé (HR 3,5 ; p = 0,001). L’utilisation combinée des scores GRACE et CRUSADE pourrait améliorer leur pouvoir discriminant en comparaison à leur utilisation isolée pour la prédiction de la mortalité globale ainsi que du risque hémorragique. Cette nouvelle approche semble apporter des avantages dans la pratique quotidienne et orienter la prise en charge thérapeutique." @default.
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- W2028873082 date "2014-12-01" @default.
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- W2028873082 title "Improving risk stratification in non-ST-segment elevation myocardial infarction with combined assessment of GRACE and CRUSADE risk scores" @default.
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- W2028873082 doi "https://doi.org/10.1016/j.acvd.2014.06.008" @default.
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