Vol. 6 (06) pp. 885-898 DOI: 10.21474/IJAR01/7289

CORRELATION BETWEEN GRACE RISK SCORE AND CARDIOVASCULAR EVENT RATE IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL FIBRINOLYSIS AND DELAYED CORONARY INTERVENTION.

, , , and
  • Cardiology Resident .
  • Lecturer of Cardiology - Faculty of Medicine - Al-Azhar University.
  • Assistant Professor of Clinical Pathology - Faculty of Medicine - Al-Azhar University.
  • Assistant Professor of Cardiology -Faculty of Medicine - Al-Azhar University.
  • Professor of Cardiology - Faculty of Medicine - Al-Azhar University.
10 Downloads 121 Views
Crossref

Download Full Paper (PDF)

Abstract

Background: In several countries, Fibrinolytic therapy represents the main reperfusion therapy for most STEMI patients due to limitation of PCI-capable hospitals. Current practice guidelines recommended routine early pharmacoinvasive (within 2?24 h) after successful fibrinolysis, however, it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. Aim of the work: to evaluate the prognostic utility of the GRACE risk score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospitals. Methods: This was a prospective cross sectional observation study that was conducted from March 2017 to February 2018 and included 120 patients presented to the coronary care unit at AL-Azhar University Hospital and Al Mataryia Teaching Hospital with acute STEMI and treated successfully with thrombolytic therapy. All patients were subjected to complete clinical assessment, serial ECGs, Echocardiography, full labs. The STEMI patients who had successfully fibrinolysis and received delayed PCI (during 24h to 14 days) were included. Follow up was done on outpatient basis monthly after delayed PCI for three months. Results: There were 70 patients (58.3%) with low GRACE score and 50 patients (41.7%) with high GRACE score. This study shows that more than three quarters of the studied cases had no follow up complications and the most frequent complication was ACS. The percentage of cases which had ACS was 13.3% (number of patients 16), the percentage of cases with HF was 9.2% ( number of patients 11), the percentage of cases with stroke was 1.7% ( 2 patients ) and only one case died. During 3 months, the cardiovascular complications occurred in 8 patients in low GRACE group and 20 patients in high GRACE group (P <0.001). Cases with cardiovascular complications had significantly higher time from successful fibrinolysis to PCI (P <0.001). Conclusion: The long delay pharmacoinvasive strategy in intermediate to high GRACE score after successful fibrinolysis in non PCI-capable facilities was associated with worse cardiovascular outcomes (death, re hospitalized with ACS, re-hospitalized with HF and stroke) than the patients with low GRACE score within 3 months.

Keywords

How to Cite This Article

Ahmed H. Elesily, Mohammed A.Mandour, Mahmoud A. Hashish, Mohy M. Samy and Mohammed S. Elbaz . (2018); CORRELATION BETWEEN GRACE RISK SCORE AND CARDIOVASCULAR EVENT RATE IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL FIBRINOLYSIS AND DELAYED CORONARY INTERVENTION., International Journal of Advanced Research (IJAR), 6 (06), 885-898, ISSN 2320-5407. DOI: https://doi.org/10.21474/IJAR01/7289

Corresponding Author

Ahmed H Elesily
Al-Azhar university Hospital

Article Analytics

References

  1. Danchin N., Di Mario C. and Falk V. et al., (2014): Folliguet T, Garg S, Huber K,James S, Knuuti J, Lopez-Sendon J, Marco J, Menicanti L, Ostojic M, PiepoliMF, Pirlet C, Pomar JL, Reifart N, Ribichini FL, Schalij MJ, Sergeant P, Serruys PW, Silber S, Uva MS, Taggart D. Guidelines on myocardial revascularization, Eur Heart J. 2014.
  2. Srimahachota S., Boonyaratavej S. and Kanjanavanit R. et al., (2012): Thai Registry in Acute Coronary Syndrome (TRACS)-An Extension of Thai Acute Coronary Syndrome Registry (TACS) Group: Lower In-hospital but still high mortality at one-year. J Med Assoc Thai. 2012 .
  3. The GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001.
  4. Eagle K., Lim M. and Dabbous O. et al., (2004): GRACE Investigators, et al. A validated prediction model for all forms of acute coronary syndromes in an international registry. JAMA. 2004.
  5. Thygesen, Alpert, Jaffe, et al., (2012): Third universal definition of myocardial infarction. Circulation, 7(4), 275-295.
  6. Leung Y, Kaplan GG, Rioux KP, Hubbard J, Kamhawi S, et al. (2012) Assessment of variables associated with smoking cessation in Crohn?s disease. Dig Dis Sci 57: 1026-1032
  7. Catapano A, Graham I, De Backer G, Wiklund O, Chapman J, et al. (2016): 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 37: 2999-3058.
  8. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, et al. (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34: 2159-2219.
  9. Vanderpump MPJ.(2005): The epidemiology of thyroid diseases. In: Braverman LE, Utiger RD, editors. Werner and Ingbar\'s The Thyroid: A Fundamental and Clinical Text. 9th edn. Philadelphia: JB Lippincott-Raven; 2005. p. 398-496.
  10. Windecker S., Kolh P. and Alfonso F. et al., (2014): ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541?619.
  11. D?Souza SP., Mamas MA. and Fraser DG. et al., (2011): Routine early coronary angioplasty vs. ischaemia-guided angioplasty after thrombolysis in acute ST elevation myocardial infarction: a meta-analysis. Eur Heart J. 2011;32(8):972?8.
  12. Eagle KA., Lim MJ. and Dabbous OH. et al., (2004): A validatedprediction model for all forms of acute coronary syndromes in aninternational registry. JAMA. 2004 .
  13. 4- Ascenzo FD., Biondi-Zoccai G. and Moretti C. et al., (2012): TIMI, GRACE and alternative risk scores in acute coronary syndromes: a metaanalysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemp Clin Trials. 2012;33:507
  14. . Scheller B., Hennen B. and Hammer B. et al., (2003): SIAM III Study Group. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 2003;42:634?41.
  15. Cantor W., Fitchett D. and Borgundvaag B. et al., (2009): TRANSFER-AMI Trial Investigators. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med. 2009;360:2705?18.
  16. Bohmer E., Hoffmann P. and Abdelnoor M. et al., (2010): Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction). J Am Coll Cardiol. 2010;55:102?10.
  17. Di Mario C., Dudek D. and Piscione F. et al., (2008): CARESS-in-AMI (Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction) Investigators. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI: an open, prospective, randomised, multicentre trial. Lancet. 2008;371:559?68.

Similar Articles

Creative Commons Attribution 4.0 This work is licensed under a Creative Commons Attribution 4.0 International License.