Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events

Granger, Christopher B.; Goldberg, Robert J.; Dabbous, O.; Pieper, Karen S.; Eagle, Kim A.; Cannon, Christopher P.; Werf, Frans Van de; Avezum, Álvaro; Goodman, Shaun G.; Flather, Marcus; Fox, Keith A.A.

doi:10.1001/archinte.163.19.2345

Cited by 1,986 publications

(1,190 citation statements)

References 38 publications

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“…2 Advancing age is an independent risk factor for short-term and long-term mortality post-MI. 2 The odds for in-hospital death escalate by 70% for every 10-year increase in age 3 and the risk of electrical and mechanical complications progressively increases with advancing age. The rate of heart failure (HF), in particular, increases markedly with age and has been associated with aging-related alterations in left ventricular (LV) wall thickness, LV ejection fraction, diastolic filling patterns, and vascular stiffness, 4 known stimuli of the NP system.…”

Section: Influence Of Age On Acs Presentation and Outcomesmentioning

confidence: 99%

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Krim

Vivo

Lemos³

2012

Clinical Cardiology

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B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT-proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT-proBNP in older individuals and their prognostic value in older patients with ACS. IntroductionThe prognostic role of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in acute coronary syndromes (ACS) remains the subject of vigorous investigation reflecting the growing interest in improving risk stratification strategies for affected patients. While a compelling body of evidence demonstrates that these biomarkers independently predict adverse outcomes, a few issues of uncertainty limit their routine use in clinical decision making. One is the question of whether existing evidence can be extrapolated to the older population. This is an important issue as approximately 82% of deaths from coronary artery disease (CAD) occur in individuals age 65 or older. 1 Fundamental to examining the value of BNP and NT-proBNP in older persons with CAD is identifying aging-related factors that may influence their levels. This review summarizes current literature describing the value of these biomarkers in older patients with ACS. The relationship of BNP and NT-proBNP with advanced age and its associated physiologic alterations is also reviewed.

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Section: Influence Of Age On Acs Presentation and Outcomesmentioning

confidence: 99%

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Krim

Vivo

Lemos³

2012

Clinical Cardiology

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“…3 The expected mortality rates from ACS increase by an odds ratio of 1.7 for each 10-year increment over age 65 years. 4 Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients and therefore, they derive a greater absolute benefit from evidencebased therapies including revascularization. However, they are also more likely to experience procedural complications, owing to age-related physiological changes, frailty, and comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Age and clinical outcomes in patients presenting with acute coronary syndromes

Ahmed

AlHabib

El‐Menyar

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tContext: Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. Aims: To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). Methods and material: Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: 50 years, 51e70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. Statistical analysis used: One-way ANOVA test for continuous variables, Pearson chi-square (X 2 ) test for categorical variables and multivariate logistic regression analysis for predictors were performed. Results: Among 7930 consecutive ACS patients; 2755 (35%) were 50 years, 4110 (52%) were 51e70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients 50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03e1.60), heart failure (OR 2.8; 95% CI 2.17e3.52) and major bleeding (OR 4.02; 95% CI 1.37 e11.77) and in-hospital mortality (age 51e70: OR 2.67; 95% CI 1.86e3.85, and age >70: OR 4.71; 95% CI 3.11e7.14). Conclusion: Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.

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“…These clinical and demographic factors have been recognized as important risk factors among patients with MI in clinical guidelines 29. Moreover, these risk factors are incorporated in a number of risk prediction models for patients with MI 6, 7, 28, 30, 31, 32, 33, 34…”

Section: Discussionmentioning

confidence: 99%

“…First, TRS2°P seems generally useful to classify 3‐year risk among patients with recent MI in a broad range of clinical settings. Although there are a few validated risk stratification tools (eg, GRACE score and TIMI risk score) for patients with acute coronary syndrome,30, 31 most of these mainly aim to predict short‐term risk (eg, in‐hospital or 14‐day) to make the decision of urgent revascularization 42, 43. Therefore, if the goal is to estimate longer‐term risk over a few years, TRS2°P would be a reasonable option.…”

Section: Discussionmentioning

confidence: 99%

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

Mok

Ballew

Bash

et al. 2018

JAHA

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BackgroundThe Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0‐to‐9‐point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting.Methods and ResultsWe evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow‐up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person‐years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C‐statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C‐statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta‐analyzed adjusted hazard ratio 1.6–1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3–1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1).ConclusionsTRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings.

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Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events

Abstract: Across the entire spectrum of ACS and in general clinical practice, this model provides excellent ability to assess the risk for death and can be used as a simple nomogram to estimate risk in individual patients.

Cited by 1,986 publications

References 38 publications

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Age and clinical outcomes in patients presenting with acute coronary syndromes

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

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