Grace Score Bias in Acute Coronary Syndrome Due to Use 1th, 2th Or Troponin Δ.
Journal Title: Revista Cuarzo - Year 2018, Vol 24, Issue 2
Abstract
Background: Acute coronary syndrome (ACS) is the first cause of mortality in Colombia. An erroneous risk stratification, in the emergency room (ER), affects the interventions performed and the rate of major cardiovascular adverse events. We measured the difference in GRACE score and stratification of coronary risk, by using the results of troponins measured sequentially during initial care. Methods: With a retrospective descriptive design, clinical records of patients treated for precor-dial pain of ≥ intermediate probability for ACS were evaluated, without indication of immediate invasive management, attended in the ER of a clinic of the third level of Bogotá, during 2017. Determined the difference between the GRACE score calculated with the first (GRACE-1), second (GRACE-2) or troponin delta (GRA-CE-delta) [paired T-test], and the proportion of poorly stratified patients was measured when using the first troponin [X2, Z-score]. Results: 44 patients in a period of 6 months were identified. The majority men, older adults, middle age 73 years. The average (SD) of scores GRACE-1, GRACE-2 and GRACE-delta, was 114.14 (30.73), 115.55 (30.14) and 111.11 (28.79), respectively; when com-paring GRACE-delta with GRACE-1 and GRACE-2 significant differences were identified (p: <0.05). Error in the stratification of coronary risk was identified in 10/44 patients (22.7%), and 9/44 (20.4%) presented over-stratification. Conclusion: The stratification of coronary risk using the first troponin, unlike the troponin delta (item not clarified in the guidelines), evidenced an over-stratification in at least 20% of the patients, establishing the need for more invasive procedures and possibly longer hospital stay.
Authors and Affiliations
Martinez, V. , Teherán, A. , González, G. , Hernández, J. , Caicedo, A. , Montoya, N. , & Villamil, L.
Treatment of Phlegmasia Cerulea Dolens with Thrombolysis; Case report.
The Flegmasia Cerulea Dolens is a rare and severe complication of deep venous thrombosis, which manifests clinically with profuse edema, pain and cyanosis of the affected lower limb. The massive obstruction of the venous...
Miller fisher syndrome: a case report and differential diagnoses
olyneuropathies of immunological origin such as Guillain-Barré syndrome (GBS) and its variant Miller-Fisher syndrome (SMF) have an incidence of 0.6 to 2.4 cases per 100,000 inhabitants per year, more frequen...
Towards an educational proposal to promote undergraduates’ professional identity
OBJECTIVE: To determine the factors associated with Professional Identity, with the aim of proposing an educational strategy that fosters it among the nursing program’s undergraduate students. METHODOLOGY: A mixed me...
Critical outcomes in pediatric patients with pulmonary hypertension and congenital cardiopathy carried out to diagnostic heart catheterization in the Cardiovascular Hospital of Soacha between 2013 and 2016
BACKGROUND: For every thousand live births in Colombia, two to three present some type of cardiac congenital anomaly; the majority of them will be associated with the development of pulmonary hypertension, which is a pat...
Evaluation of plant extracts in the management of caustic burns: Irritation / Acute dermal corrosion. Bogotá-2018
Introduction: Considering that caustic burns represent a low percentage of burns, given the com-plications they could associate, they are a public health problem that requires new therapeutic options such...