Zohaib Akhter, Irfan Ali Rind, Saba Aijaz, Saadia Sattar, Rehan Malik, Asad Pathan.
Management, hospital outcome and revascularization trends in non-ST elevation myocardial infarction with high GRACE risk score.
J Pak Med Assoc Jan ;69(10):1486-92.

Objective: To assess clinical characteristics, management strategies and in-hospital outcome among high-risk patients of non-ST elevation myocardial infarction. Methods: The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2016 of adult non-ST elevation myocardial infarction patients who had first cardiac event having Global Registry of Acute Coronary Eventsrisk score>140. Subcategories were formed on the basis of score range 140-159, 160-189 and ?190.Stata 12.1 was used for data analysis. Results: Of the 817 patients, 567(69.4%) were men. Overall, mean age was 66.3+-9.3 years. Coronary angiography was performed in 692(84.4%). With higher risk score categories, there was less frequent use of guideline directed medical therapy, coronary angiography and percutaneous or surgical revascularisation (p<0.05 each). Overall mortality was 59(7.2%). Mortality rates increased with increase in risk score subcategory (p<0.05). Multivariable model identified higher risk score category, no revascularisation and lack of guideline directed medical therapy as significant independent predictors of mortality (p<0.05 each). Conclusion: Mortality increased with higher risk score category. Paradoxically, high-risk patients were less likely to receive guideline directed medical therapy, to undergo coronary angiography and revascularisation, possibly suggesting a risk aversion approach by the treating physicians.

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