A Look at Results from a GRACE Registry Study

by Rajashri on September 2, 2009 at 9:30 PM
 A Look at Results from a GRACE Registry Study

The Global Registry of Acute Coronary Events (GRACE) was launched in 1999 and is the world's largest international database tracking outcomes of patients presenting with acute coronary syndromes (ACS). The latter includes myocardial infarction or unstable angina.

GRACE data are derived from 247 hospitals in North America, South America, Europe, Asia, Australia and New Zealand, and from more than 100,000 patients with ACS. Data from 43,018 ACS patients in the Registry were analysed to determine the optimal revascularisation strategy for unprotected left main coronary disease, which has so far been little studied.


Results of the analysis showed that unprotected left main coronary disease (ULMCD) in ACS is associated with high in-hospital mortality, especially in patients presenting with STEMI (ST segment elevation myocardial infarction) and/or hemodynamic or arrhythmic instability. PCI (percutaneaous coronary intervention) is now the most common revascularisation strategy in this population, and is preferred in higher-risk patients. CABG (coronary artery bypass grafting) is often delayed and is associated with the best 6-month survival. The two approaches therefore appear complementary in this high-risk group.


Of the 43,018 patients in the analysis, 1799 had significant ULMCD and underwent PCI alone (n=514), CABG alone (n=612), or no revascularisation (n=673). Mortality was 7.7% in hospital and 14% at six months.

Over the eight-year study period, the GRACE risk score remained constant, 20 points higher in PCI than in CABG, but there was a steady shift to more PCI than CABG revascularisation over time.* Patients undergoing PCI presented more frequently with acute myocardial infarction, after cardiac arrest, or in cardiogenic shock; 48% of PCI patients underwent revascularisation on the day of admission vs. 5.1% in the CABG group. After adjustment, revascularisation was associated with an early hazard of hospital death compared with no revascularisation, significant for PCI (HR 2.60, 95% CI 1.62-4.18) but not for CABG (HR 1.26, 95% CI 0.72-2.22).

From discharge to six months, both PCI (HR 0.45, 95% CI 0.23-0.85) and CABG (HR 0.11, 95% CI 0.04-0.28) were significantly associated with improved survival in comparison with an initial strategy of no revascularisation. CABG revascularisation was associated with a five-fold increase in stroke compared with the other two groups.

Says investigator Professor Gilles Montalescot from the Hôpital Pitié-Salpétrière in Paris: "The results show that CABG surgery and PCI are not used in similar types of patients and provide complementary treatment options in ACS."

Source: Eurekalert
Font : A-A+



Latest Heart Disease News

Smart Watch Helps Detect Irregular Heart Rhythm
Atrial fibrillation (irregular heart rhythm) can be accurately diagnosed with Verily Study Watch, the FDA-approved wrist-worn gadget.
Red Flags in Red Cells — Decoding Their Threat on Heart Health!
According to health experts, an increased risk of heart attack, stroke, and blood clots is associated with higher hemoglobin levels.
Atherosclerosis in Young Adults Curbed by Early Risk Factor Management
Early cardiac evaluation reverses atherosclerosis caused by cardiac risk factors like high BP and high cholesterol in young adults.
Summer Wildfires and Winter Air Pollution Pose Varied Heart Health Risks
PM2.5 increases during winter inversions are associated with higher heart attack risk, stated study.
Genetic Testing Identifies High Cholesterol Risk, Preventing Heart Events
The study underscores the significance of broader genetic testing for familial hypercholesterolemia, a genetic disorder that causes high bad cholesterol levels.
View All
This site uses cookies to deliver our services.By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use  Ok, Got it. Close

A Look at Results from a GRACE Registry Study Personalised Printable Document (PDF)

Please complete this form and we'll send you a personalised information that is requested

You may use this for your own reference or forward it to your friends.

Please use the information prudently. If you are not a medical doctor please remember to consult your healthcare provider as this information is not a substitute for professional advice.

Name *

Email Address *

Country *

Areas of Interests