Clinical Value of GRACE Score in the Prediction of Mortality in Patients with Acute Coronary Syndrome / 대한구급학회지

BACKGROUND: This study was aimed to evaluate the validity of the Global Registry of Acute Coronary Event (GRACE) in patients with acute coronary syndrome (ACS). METHODS: One thousand thirty hundred seventy eight patients (63.6+/-12.0 years, 921 male), who were admitted at coronary care unit (CCU) of Chonnam National University Hospital between January 2004 and December 2005, were analyzed. The patients were divided into two groups: the survived group (n=1,298, 871 male, 63.1+/-9.7 years) and the moribund group (n=80, 50 male, 67.4+/-8.5 years). Clinical characteristics, risk factors for atherosclerosis, echocardiographic findings, GRACE score and NT-proBNP were compared between groups. RESULTS: The overall mortality was 5.8 %, 80 out of 1,378 patients. Mortality was higher in patients with Killip IV (46.7%, 50 out of 107 patients) than Killip II or III and elderly patients more than 80 years (42.7%, 38 out of 89 patients). High Killip class and old age were associated with high mortality (p<0.0001 respectively). Total score of GRACE was elevated in the moribund group (142+/-40.3 vs. 240+/-40.0) and high GRACE score was significant predictor of mortality (p<0.0001, r=0.827). Predictive factors for mortality by multiple logistic regression analysis were GRACE score (OR 1.15, 1.11~1.20 95%CI, p<0.0001) and old age (OR 0.88, 1.14~1.33 95%CI, p<0.001). CONCLUSIONS: GRACE score is useful predictor for the mortality of ACS at CCU.

The predictive factor of mortality and prognosis of cardiovascular patients admitted at coronary care unit / 대한내과학회지

BACKGROUND: The mortality rate of cardiovascular patients has been decreased after the introduction of coronary care unit (CCU), however data about that of Korean patients is rare. METHODS: Two thousand and eighty one patients (63.6+/-14.6 years, 1,295 male), who were admitted at CCU of Chonnam National University Hospital between January 2002 and June 2004, were analyzed. The admitted patients were divided into two groups: the survival group (Group I: n=1,926, 1,205 male, 62.3+/-13.9 years) and the death group (Group II: n=155, 90 male, 64.9+/-15.3 years). Clinical characteristics, risk factors for atherosclerosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 7.4% (155 out of 2,081 patients). Mean age and sex ratio were not different between the two groups. Coronary artery disease was the most common causes of both admission (1,606 out of 2,081 patients) and death (107 out of 155 patients). The clinical diagnoses of group II were myocardial infarction (n=70), unstable anginas (n=30), variant angina (n=2), congestive heart failure (n=17), aortic dissection (n=14) and arrhythmia (n=34). Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (56.2+/-20.7% vs. 42.6+/-17.1%, p<0.001). Predictive factors for mortality according to multiple logistic regression analysis were low LVEF, use of intra-aortic balloon pump (IABP), inability to perform percutaneous coronary intervention (PCI) and high level of myoglobin. CONCLUSIONS: Death due to acute coronary syndrome was most common cause of CCU mortality. Decreased LVEF, insertion of IABP, inability to perform PCI and high myoglobin were associated with mortality of CCU admitted patients.