Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A Randomized Clinical Trial.
Derek P Chew1, Karice Hyun2,3, Erin Morton1
1College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia.
JAMA Cardiology
|December 9, 2020
Summary
Implementing the Global Registries of Acute Coronary Events (GRACE) risk score (GRS) increased early invasive treatment for acute coronary syndrome (ACS) patients. However, it did not improve other guideline-indicated care aspects or reduce mortality and myocardial infarction rates.
Area of Science:
- Cardiology
- Clinical Trials
- Health Services Research
Background:
- International guidelines recommend the Global Registries of Acute Coronary Events (GRACE) risk score (GRS) for guiding acute coronary syndrome (ACS) treatment.
- The prospective utility of the GRS in improving patient care and outcomes remains unproven.
Purpose of the Study:
- To assess the impact of routine GRS implementation on guideline-indicated treatments and clinical outcomes in hospitalized ACS patients.
Main Methods:
- A prospective, cluster randomized trial involving 24 hospitals.
- Patients with ST-segment elevation or non-ST-segment elevation ACS were enrolled.
- The primary outcome was a performance score based on early invasive treatment, guideline-recommended pharmacotherapies, and cardiac rehabilitation referral.
Main Results:
- The study enrolled 2318 patients and was stopped prematurely due to futility.
- Routine GRS implementation increased early invasive treatment (91.8% vs. 83.6%) but did not significantly affect pharmacotherapy prescription or cardiac rehabilitation referral.
- No significant reduction in the composite outcome of all-cause death or myocardial infarction at 12 months was observed (9.2% vs. 13.4%).
Conclusions:
- Routine GRS implementation in high-level cardiology services increased early invasive treatment but did not improve other care aspects.
- Low event rates and premature study discontinuation highlight the need for larger-scale randomized studies to confirm the GRS's clinical utility.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
4.0K
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
5.6K
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
106
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
106
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
272
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
272
01:30Acute Coronary Syndrome III: Diagnostic Studies
97
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
97
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
165
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
165
01:26Acute Coronary Syndrome V: Nursing Management
139
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
139
01:30Acute Coronary Syndrome I: Introduction
347
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
347