Use of clinical risk stratification in non-ST elevation acute coronary syndromes: an analysis from the CONCORDANCE registry

There is little information on clinical risk stratification (CRS) compared to objective risk tools in patients with non-ST elevation acute coronary syndromes (NSTEACS). We quantified CRS use, its agreement with Global Registry of Acute Coronary Events (GRACE) risk scores (GRS), and association with...

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Bibliographic Details
Published in:European heart journal. Quality of care & clinical outcomes 2018-10, Vol.4 (4), p.309-317
Main Authors: Bing, Rong, Goodman, Shaun G, Yan, Andrew T, Fox, Keith, Gale, Chris P, Hyun, Karice, D'Souza, Mario, Shetty, Pratap, Atherton, John, Hammett, Chris, Chew, Derek, Brieger, David
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - epidemiology
Acute coronary syndromes
Aged
Biomarkers
Cardiology
Cardiovascular disease
Coronary vessels
Dementia
Diabetes
Electrocardiography
Female
Global Health
Heart attacks
Heart failure
Hospitals
Humans
Male
Medical records
Mortality
Patients
Prognosis
Registries
Reproducibility of Results
Retrospective Studies
Risk Assessment - methods
Risk Factors
Severity of Illness Index
Stroke
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Summary:There is little information on clinical risk stratification (CRS) compared to objective risk tools in patients with non-ST elevation acute coronary syndromes (NSTEACS). We quantified CRS use, its agreement with Global Registry of Acute Coronary Events (GRACE) risk scores (GRS), and association with outcomes. Data were extracted from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE), a multi-centre NSTEACS registry. From February 2009 to December 2015, 4512 patients from 41 sites were included. Predictors of CRS use and association with treatment were identified, CRS-GRS agreement determined and prediction of in-hospital and 6-month mortality compared. Clinical risk stratification was documented in 21% of patients. Family history of coronary disease was the only independent predictor of CRS use [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.04-1.45]; electrocardiogram changes (OR 0.8, 95% CI 0.68-0.96), elevated biomarkers (OR 0.59, 95% CI 0.48-0.73), dementia (OR 0.56, 95% CI 0.36-0.84), and an urban hospital setting (OR 0.41, 95% CI 0.19-0.89) were independent negative predictors. A treatment-risk paradox was observed: high CRS risk patients received less anticoagulation (79% vs. 88%, P = 0.001) and angiography (83% vs. 71%, P 
ISSN:2058-5225
2058-1742
DOI:10.1093/ehjqcco/qcy002