According to Kerala and Himachal Pradesh ACS registries, NSTE-ACS accounts for. NSTE-ACS causes 2-2.5 million annual worldwide hospitalizations. This may be due to change in the demography of population, growing number of aging population, and increase incidence of obesity and diabetes mellitus. The number of patients with non ST elevation acute coronary syndrome (NSTE ACS) as compared to ST elevation myocardial infarction is increasing. Patients without typical symptoms and serial negative biomarkers of necrosis are diagnosed as UA. NSTEMI is defined by Electrocardiography (ECG) ST-segment depression or prominent T-wave inversion with positive biomarkers of necrosis in the absence of persistent (<20 min) ST-segment elevation. Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) constitutes a clinical syndrome subset of the acute coronary syndrome (ACS) that is usually, but not always, caused by atherosclerotic CAD and is associated with an increased risk of cardiac death and subsequent myocardial infarction. Ischemic heart disease contributed to 17.8% of total deaths and 8.7% of total disability-adjusted life years in India. Among these, coronary artery disease (CAD) is the most common and is associated with high rate of mortality and morbidity. Conclusions: Both the GRACE and TIMI risk scores were a good predictor of angiographic severity of CAD in patients with NSTE-ACS, and the GRACE score was found to be superior to the TIMI risk score.Ĭardiovascular diseases are currently the leading cause of mortality and morbidity in industrialized countries. Risk factors such as higher age, hypertension, smoking history, dyslipidemia, ECG changes such as ST deviation and T inversion, and Killip classification showed a statistically significant association with severity of disease. The area under the ROC curve for the GRACE score was 0.765 (95% confidence interval = 0.676-0.854), significantly superior to the area under the ROC curve of the TIMI score (0.715 95% CI = 0.618-0.812). Results: A positive association between the Gensini score and vessel score was observed with both the GRACE (P = 0.001) and TIMI (P = 0.001) scores. The receiver operating characteristic (ROC) curve was applied for the predictability of GRACE and TIMI scores for severity of disease. For comparison of two means, independent sample t-test/Mann-Whitney U-test was used, while for more than two means, one-way ANOVA/Kruskal-Wallis test was used. Statistical Analysis Used: SPSS software version 27.0 was used for statistical analysis. Coronary angiogram was done and the Gensini score and vessel score were used to assess the severity of CAD. The GRACE and TIMI scores were estimated. Subjects and Methods: Total 202 NSTE-ACS (NSTE myocardial infarction and unstable angina) patients were included. Settings and Design: This was an observational cross-sectional study. Aims: We aimed to compare the GRACE score with TIMI risk score for prediction of the angiographic severity of coronary artery disease (CAD) in patients with NSTE-ACS. SatapathyĬontext: The Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in predicting coronary disease severity in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) have not been proved. Early invasive strategy resulted in lower in-hospital mortality and marginally shorter length of stay but higher hospitalization cost in NSTE-ACS with COPD.Ĭhronic obstructive pulmonary disease early invasive ischemia-guided strategy non-ST-segment elevation acute coronary syndromes.Byline: Satyanarayan. Length of stay was shorter (4.2 vs 4.7 days, P <. In-hospital mortality was lower with EIS in patients with COPD (3.1% vs 5.5%, adjusted odds ratio 0.57, 95% confidence interval 0.50-0.63) compared to IGS, but the magnitude of mortality reduction observed in EIS in patients with COPD was less compared to non-COPD patients ( P interaction =. A total of 228 175 NSTE-ACS admissions with COPD were identified of which 34.0% received EIS. Management of NSTE-ACS depends on a patients mortality risk (e.g., TIMI score), clinical findings, and the availability of resources. 2 Risk-dependent timing of revascularization 2 11. Standardized morbidity ratio weight was used to calculate the adjusted odds ratio. The following recommendations are generally consistent with the 2014 AHA/ACC guidelines for the management of NSTE-ACS. Early invasive strategy was defined as coronary angiogram with or without revascularization on admission day 0 or 1, whereas IGS included patients who did not receive EIS. Nationwide Inpatient Sample database of the United States was queried from 2010 to 2015 to identify NSTE-ACS with and without COPD. Whether early invasive strategy (EIS) or ischemia-guided strategy (IGS) confers better outcomes in NSTE-ACS with COPD is largely unknown. Chronic obstructive pulmonary disease (COPD) is a risk factor for non-ST-segment elevation-acute coronary syndromes (NSTE-ACS).
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