Use of Global Registry of Acute Coronary Events (GRACE) scoring in the management of chest pain patients with suspected acute coronary syndrome in the emergency department

Year 2023, , 170 - 174, 29.12.2023

Bora Kaya , Yavuz Yiğit , Emrah Çelik , Serkan Yılmaz

https://doi.org/10.54996/anatolianjem.1374349

Abstract

Aim: Acute coronary syndrome (ACS) has been developed as a useful operational term to refer to a range of disorders consistent with acute myocardial ischemia and/or infarction, usually due to a sudden decrease in coronary blood flow. Global Registry of Acute Coronary Events (GRACE) is an international database designed to monitor the outcomes of patients presenting with Non-ST-elevation Myocardial Infarction (NSTEMI) and unstable angina pectoris. The aim of this study is to determine the use of GRACE scoring in predicting major cardiac events in outpatients with chest pain and to evaluate the effects it may have on the patient's follow-up period and number of examinations in the emergency department when applied to patient management.

Material and Methods: Adult patients (>18 years old) who applied to our emergency department and patients with suspected chest pain of cardiac origin in the hospital or before the hospital were included in the study, and clinical, anamnesis data and coronary artery disease risk factors were recorded prospectively. The information of patients with GRACE score data was obtained with "The GRACE 2.0 ACS Risk Calculator app" running on the iOS operating system. All patients were followed for major cardiac events (acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, and death from any cause) within 6 weeks from the first admission.

Results: Of the 167 patients admitted to the emergency department, 117 were men (70.1%) and 50 were women (29.9%). No statistically significant relationship was found between the numerical values of GRACE scores and the development of major cardiac event (MCO) (p = 0.358, t = -.922). On the other hand, when the difference in GRACE scores was evaluated between patients with two negative troponin values and other patients, a significant difference was found (p = 0.02). When the follow-up periods in the emergency department were compared between patients whose troponin values were found to be negative twice and those whose second and third troponin values were positive, a significant difference was found (p<0.001). A significant difference was found in follow-up times between those whose first troponin value was positive and those whose second troponin value was negative (p = 0.015).

Conclusion: GRACE scoring may be of limited benefit in the management of patients with chest pain who present to the emergency department.

Keywords

GRACE, acute coronary syndrome, chest pain

Acil serviste akut koroner sendrom şüphesi olan göğüs ağrılı hastaların yönetiminde Global Registry of Acute Coronary Events(GRACE) skorlamasının kullanımı

Abstract

Amaç: Akut koroner sendrom (AKS), genellikle koroner kan akımındaki ani bir düşüşe bağlı akut miyokard iskemisi ve/veya enfarktüs ile uyumlu bir dizi rahatsızlığa değinen kullanışlı bir operasyonel terim olarak geliştirilmiştir. Global Registry of Acute Coronary Events (GRACE), Non ST elevasyonlu Miyokart infarktüsü(NSTEMİ) ve anstabil anjina pektoris ile başvuran hastaların sonuçlarını izlemek üzere tasarlanmış uluslararası bir veritabanıdır. Bu çalışmanın amacı acil serviste AKS düşünülerek takip edilen göğüs ağrılı hastalarda GRACE skorlamasının, ayaktan hastalarda majör kardiyak olayların öngörülmesinde kullanımını belirlemek ve hasta yönetiminde uygulandığında hastanın acil serviste takip süresi ve tetkik sayıları üzerine olabilecek etkilerini değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya, acil servisimize başvuran yetişkin (>18 yaş), hastanede veya hastane öncesinde kardiyak kökenli göğüs ağrısı şüphesi bulunan hastalar dahil edilerek, klinik, anamnez verileri ve koroner arter hastalığı risk faktörleri prospektif olarak kaydedilmiştir. GRACE skoru verilerine sahip hastaların bilgileri İos işletim sisteminde çalışan “The GRACE 2.0 ACS Risk Calculator app” ile yapılmıştır. Tüm hastalar ilk başvurudan itibaren 6 hafta içinde majör kardiyak olaylar açısından (akut miyokart enfarktüsü, perkutan koroner girişim, koroner arter bypass cerrahisi ve herhangi bir sebepten ölüm) takip edilmiştir.

Bulgular: Acil servise başvuran toplam 167 hastanın 117’si erkek (%70,1) ve 50’si kadın (%29,9)’dı. GRACE skorlarının sayısal değerleri ile majör kardiyak olay gelişmesi arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (p=0.358, t=-,922). Öte yandan iki troponin değeri negatif olan hastalarla diğer hastalar arasında GRACE skorlarının farklılığı değerlendirildiğinde arada anlamlı fark bulunmuştur(p=0.02). Troponin değeri iki kez negatif bulunan hastalar ile ikinci ve üçüncü troponin değeri pozitif bulunan hastaların acil serviste takip süreleri karşılaştırıldığında arada anlamlı fark bulunmuştur(p<0.001). İlk troponin değeri pozitif olanlar ile ikinci troponin negatif olanlar arasında takip süreleri açısından anlamlı fark bulunmuştur (p=0.015).

Sonuç: GRACE skorlaması acil servise başvuran göğüs ağrılı hastaların yönetiminde sınırlı da olsa fayda sağlayabilir ancak tanı ve tedaviye katkılarının gösterilmesi için daha geniş çalışmalara ihtiyaç vardır.

Keywords

GRACE, akut koroner sendrom, göğüs ağrısı

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