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Clinical effectiveness of the systematic use of the GRACE scoring system (in addition to clinical assessment) for ischaemic outcomes and bleeding complications in the management of NSTEMI compared with clinical assessment alone: a prospective study

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Abstract

We assessed the interest of systematically using the GRACE scoring system (in addition to clinical assessment) for in- hospital outcomes and bleeding complications in the management of NSTEMI compared with clinical assessments alone. Multicentre, randomized study that included 572 consecutive NSTEMI patients, randomized 1:1, into group A: clinical stratification alone and group B: clinical+ GRACE score stratification. Main outcome measures: in-hospital outcomes and bleeding complications. There was no significant difference between the two groups for baseline data or for in-hospital MACE. In multivariate analysis, only a GRACE >140 (OR: 3.5, 95 % CI: 1.8–6.6, p < 0.001) and PCI (OR: 0.55, 95 % CI: 0.3–1.0; p = 0.05) were independent predictors of in-hospital MACE. The sub-analysis of group B showed that 56 patients (20 %) were given a compliance score of 0, showing that diagnostic angiography was performed later than as recommended by the guidelines. Interestingly, 91 % had a GRACE score >140, and these patients were significantly older, and were more likely to have a history of diabetes, stroke and renal failure, together with symptoms of heart failure. After multivariate analysis, the independent predictors of a lack of compliance with guideline delays were a GRACE score >140 (OR: 9.2; CI: 4.2–20.3, p < 0.001) and secondary referral from a non-PCI cardiology department (OR: 2.7; CI: 1.4–5.2, p = 0.003). In a real-world setting of patients admitted with NSTEMI, the systematic use of the GRACE scoring system at admission in the PCI centre does not improve in-hospital outcomes and bleeding complications.

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Acknowledgments

We wish to thank Edith Fusier, Florence Bichat and Aline Chagnon for their research assistance, Marianne Zeller for the statistical support and Philip Bastable for Editorial assistance. This work was supported by the University Hospital of Dijon, the Faculty of Medicine of Dijon, the Association de Cardiologie de Bourgogne, and by grants from the Union Régionale des Caisses d’Assurance Maladie de Bourgogne (URCAM), the Agence Regionale de Santé (ARS) de Bourgogne, the Conseil Régional de Bourgogne and the Fédération Française de Cardiologie (FFC).

Conflict of interest

The authors have no potential conflicts of interest to disclose in connection with the submitted article.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital, Dijon, France

    Charles Guenancia, Karim Stamboul, Olivier Hachet, Valentin Yameogo, Fabien Garnier, Aurélie Gudjoncik, Yves Cottin & Luc Lorgis

  2. LPPCM, INSERM U866, University of Burgundy, Dijon, France

    Charles Guenancia, Karim Stamboul, Olivier Hachet, Aurélie Gudjoncik, Yves Cottin & Luc Lorgis

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  1. Charles Guenancia
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Correspondence to Charles Guenancia.

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Guenancia, C., Stamboul, K., Hachet, O. et al. Clinical effectiveness of the systematic use of the GRACE scoring system (in addition to clinical assessment) for ischaemic outcomes and bleeding complications in the management of NSTEMI compared with clinical assessment alone: a prospective study. Heart Vessels 31, 897–906 (2016). https://doi.org/10.1007/s00380-015-0695-8

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