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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the value of the 8-parameter Global Registry of Acute Coronary Events (GRACE) risk score [The GRACE Investigators. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2001] in predicting the 1-year mortality of patients discharged with acute coronary syndrome (ACS).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMichael Chin, DM, University of the West Indies, Trinidad and Tobago, described the value of the 8-parameter Global Registry of Acute Coronary Events (GRACE) risk score [The GRACE Investigators. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2001] in predicting the 1-year mortality of patients discharged with acute coronary syndrome (ACS).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EACS causes about 50% of all cardiovascular-related deaths, and the 1-year survival of ACS patients depends on a variety of patient-related factors and the care received during hospitalization [Lloyd-Jones D et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2010]. Management of ACS patients is challenging in a resource-limited setting. Identifying patients at higher risk who may benefit from more aggressive treatment, such as early invasive strategies and coronary care unit monitoring, could help to allocate available resources in an optimal way.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThree risk scores\u2014Thrombosis in Myocardial Infarction, Platelet Glycoprotein IIb\/IIIa in Unstable Angina: Receptor Suppression Using in Tegrilin, and GRACE\u2014are recommended for patient stratification [de Ara\u00fajo Gonsalves P et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2005]. All, especially GRACE, have good predictive accuracy for death and myocardial infarction before discharge and up to 1 year following discharge.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe GRACE investigators previously showed the utility of the GRACE risk score in predicting in-hospital mortality (8.3% of 372 patients) in a multiethnic population in the resource-limited setting of Trinidad and Tobago. The present study analyzed follow-up data in the 341 survivors following hospital discharge to explore whether the GRACE score is valuable in predicting 1-year mortality.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe majority of the patients (n = 207 of 341) were aged \u0026gt; 60 years, and about 72% were of Indian ethnicity. The presenting ACS was categorized as STEMI (ST segment elevation myocardial infarction; 25.2%), non-STEMI (54.3%), and unstable angina pectoris (20.5%).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe baseline characteristics of patients in the hospitalized and discharged groups in the present study were similar, with both groups differing from the original GRACE study (which predominantly involved Caucasian patients) in terms of the prevalence of diabetes mellitus and hypertension (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/13\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Baseline Characteristics\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-218783307\u0022 data-figure-caption=\u0022Baseline Characteristics\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/13\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/13\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/13\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14784\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EBaseline Characteristics\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECABG=coronary artery bypass grafting; PCI=percutaneous coronary infarction.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from M Chin, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThe GRACE risk category distribution was fairly even, with high, intermediate, and low risk constituting 30.2%, 34.9%, and 34.9% of the discharged patients, respectively. However, subjects who died were predominantly in the high-risk group (31.5%), compared with the intermediate- (8.3%) and low-risk (3.5%) groups. Predictors of 1-year mortality included age, creatinine, elevated cardiac enzymes, heart rate at admission, Killip class, history of chronic kidney disease, and the GRACE risk score.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe results of the present study extend the utility of the GRACE risk score from a predominantly Caucasian population to patients from a developing (resource-limited) country with a multiethnic population.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/24\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzovr2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzovr2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}