Abstract 13790: Treatment, Costs, and 12-Month Outcomes by GRACE Risk Score in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Objectives To assess treatment, costs, and 12-month outcomes by Global Registry of Acute Coronary Events (GRACE) risk score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
Methods: Patients in the Antiplatelet Treatment Observational Registry (APTOR)-II, with data from 11 European countries from 2008-2009, were stratified according to their GRACE risk score (unstable angina [UA]/non-ST-elevated myocardial infarction [NSTEMI]: ≤108 low, 109-140 intermediate, ≥141 high; STEMI patients: ≤125 low, 126-154 intermediate, ≥155 high). Treatment (medical care at and over 12 months from PCI), timing of PCI, total 12-month costs, and Kaplan-Meier (KM) estimates 12-months post-PCI for CV event (UA, NSTEMI, STEMI, urgent target vessel revascularization, acute heart failure, stent thrombosis, ischemic and hemorrhagic strokes and CV death) and mortality were assessed.
Results: The number of patients by GRACE risk score (percentage presenting with UA/NSTEMI and STEMI, respectively), were: 1024 with low risk (57%, 43%), 1098 with intermediate risk (47%, 53%), and 675 with high risk (43%, 57%). In the low-, intermediate-, and high-risk groups, respectively, 38%, 36%, and 31% of UA/NSTEMI and 81%, 82%, and 84% of STEMI patients underwent PCI within 24 hours of the ACS event. In all risk groups, patients received similar treatment at hospital discharge and adhered to treatment 12-months post-PCI. The KM estimates (95% CI) 12-months post-PCI for patients in the low-, intermediate-, and high-risk groups, respectively, were 14.0% (11.9, 16.2), 15.5% (13.3, 17.6), 20.9% (17.8, 24.0) for CV event, 0.6% (0.1, 1.1), 1.6% (0.8, 2.3), and 6.4% (4.5, 8.2) for mortality, and mean total costs were £5,356 (£5035, 5708), £5,776 (£5441, 6142), and £6,399 (£5920, 6939). More CV events and mortality were observed with UA/NSTEMI than STEMI patients in the high-risk group.
Conclusions: GRACE risk score was associated with CV event, mortality, and total costs. The timing of PCI and treatment for UA/NSTEMI patients in the high-risk group should be investigated.
- © 2011 by American Heart Association, Inc.