Síndrome coronario agudo en nonagenarios: evolución clínica y validación de las principales escalas de riesgo |
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Authors: | Sandra Gó mez-Talavera,Ivá n Nú ñ ez-Gil,David Vivas,Borja Ruiz-Mateos,Ana Viana-Tejedor,Agustí n Martí n-Garcí a,Javier Higueras-Nafrí a,Carlos Macaya,Antonio Ferná ndez-Ortiz |
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Affiliation: | 1. Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España;2. Servicio de Cardiología, Hospital de la Cruz Roja San José y Santa Adela, Madrid, España |
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Abstract: | IntroductionSeveral risk scores regarding the probability of death/complications in the acute setting and during the follow-up of patients admitted with acute coronary syndromes (ACS) have been published, such as the GRACE, TIMI and ZWOLLE risk score. Our objective was to assess the prognosis of nonagenarians admitted to a coronary care unit with an ACS, as well as the usefulness of each of these scores.Material and methodsA retrospective analysis was performed on nonagenarians with an ACS admitted between 2003 and 2011. Vital status was determined at 14, 30 days, and 6 months after the ACS, and later during the follow-up. The risk scores were evaluated by area under the curve ROC (AUC).ResultsA total of 45 patients with an ACS, 26 (57.8%) with ST-segment elevation and 19 (42.2%) with non-ST elevation. The GRACE- AUC for in-hospital mortality was excellent, 0.91, (95% CI: 0.82-1; P<.001), and for the combined event (in-hospital mortality and re-infarction) was 0.83 (95% CI: 0.66-1.0; P<.01). However, the GRACE-AUC at 6 months for mortality was 0.34 (95% CI: 0.09-0.58; P=.45), and for the combined event it was 0.51 (95% CI: 0.26-0.77; P=.95). The TIMI-AUC and ZWOLLE-AUC did not reach statistical significance.ConclusionsIt is useful calculate the GRACE risk score in order to estimate risk and survival in the acute phase of ACS in nonagenarians. This can help appropriate in making invasive or conservative treatment decisions. |
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Keywords: | Estratificació n de riesgo Sí ndrome coronario agudo Escala de riesgo GRACE Nonagenarios |
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