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Original research
GRACE score and cardiovascular outcomes prediction among the delayed coronary intervention after post-fibrinolytic STEMI patients in a limited PCI-capable hospital
  1. Yotsawee Chotechuang1,2,
  2. Arintaya Phrommintikul3,
  3. Srun Kuanprasert3,
  4. Roungtiva Muenpa4,
  5. Chidchanok Ruengorn5,6,
  6. Jayanton Patumanond7,8,
  7. Tuanchai Chaichuen9,
  8. Noparat Thanachaikun3,
  9. Thanawat Benjanuwatra3 and
  10. Apichard Sukonthasarn3
  1. 1Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
  2. 2Clinical Epidemiology Program, Clinical Epidemiology and Clinical Statistics Center, Department of Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  3. 3Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  4. 4Department of Pharmacy, Lampang Hospital, Lampang, Thailand
  5. 5Department of Pharmaceutical Care, Faculty of Pharmacy, Chiangmai University, Chiang Mai, Thailand
  6. 6Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiangmai University, Chiang Mai, Thailand
  7. 7Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
  8. 8Department of Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  9. 9Cardiac Catheterization Laboratory Unit, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  1. Correspondence to Dr Arintaya Phrommintikul; arintayap{at}yahoo.com

Abstract

Background In Thailand, due to limited availability of percutaneous coronary intervention (PCI)-capable hospitals, a number of patients with ST-elevation myocardial infarction (STEMI) after fibrinolytic therapy underwent the delayed coronary intervention (24 hours to 2 weeks). Existing tool such as the Global Registry of Acute Coronary Event (GRACE) to define patients at high risk of cardiovascular outcomes has been used widely, except for patients who had the delayed coronary intervention. We, therefore, evaluated the cardiovascular outcomes of STEMI patients who underwent the delayed coronary intervention.

Methods We retrospectively analysed the data from the PCI-capable hospital (Maharaj Nakorn Chiang Mai Hospital) STEMI registry during the period 2007–2012. Patients who received fibrinolytic treatment (SK) and underwent the delayed coronary intervention were included. The outcomes of the study were 30-day and 6-month composite cardiovascular outcomes (including death, re-hospitalised with acute coronary syndrome, re-hospitalised with heart failure and stroke).

Results Of all 341 patients included, 229 (67.2%) patients were in the low GRACE score group (<126 points) and 112 (32.8%) patients in the intermediate-high GRACE score group (≥126 points). At 30 days, the composite cardiovascular outcome occurred in 2.2% (n=5) in the low GRACE score group and 11.6% (n=13) in the intermediate-high GRACE score group (p value=0.001). At 6 months, the composite cardiovascular outcomes occurred in 3.9% (n=9) in the low GRACE score group and 13.4% (n=15) in the intermediate-high GRACE score group (p value=0.003). The area under the receiver operating characteristic curve of GRACE score for 6-month composite cardiovascular outcomes was 0.746 (95% CI 0.698 to 0.793).

Conclusion Intermediate-high GRACE risk STEMI patients after fibrinolytic therapy in limited PCI-capable hospital who underwent the delayed coronary intervention increased 30-day and 6-month cardiovascular outcomes compared with the low GRACE risk patients. In limited available PCI-capable hospital, GRACE risk score can be helpful in guiding the cardiologists to select a proper time for coronary intervention in post-fibrinolytic STEMI patients.

  • GRACE score
  • ST-elevation myocardial infarction
  • fibrinolytic therapy
  • delayed coronary intervention
  • limited PCI-capable hospital
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Footnotes

  • Contributors All authors made substantial contributions to conception, design and drafting the manuscript. YC designed the study, conducted the data collection, analysis and prepared the manuscript. AP, SK, RM, CR, JP, TC, NT, TB and AS conducted a critical review of the manuscript and provided final editing to the manuscript. All authors read and approved the final manuscript.

  • Funding Funding used to conduct this study and prepare this manuscript was supported by Faculty of Medicine, Chiang Mai University.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was reviewed and approved by the Research Ethics Committee 4, Faculty of Medicine, Chiang Mai University and Research Ethics Committee of Lampang Hospital. Informed consent was confirmed by the Research Ethic Committee 4, Faculty of Medicine, Chiang Mai University. The patient’s inform consent was waived due to the nature of retrospective study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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