Abstract

GRACE SCORE IN ASSESSING THE IN-HOSPITAL MORTALITY OF ACS AND THE EVALUATION OF RISK FACTORS

Author(s): Ponnaian John Christopher, Benitta Mary Redleene, Sivanesan, Jenix Nathan

BACKGROUND
In India, cardiovascular diseases account for 25% of the total deaths. The survival of patients with acute myocardial infarction has improved considerably during the past 10 years with the advent of PCI & cardioprotective drugs. Despite this improvement, mortality rates after MI continue to demonstrate an early rise. Therefore, risk stratification is necessary to identify high risk patients. There are various risk scores to predict mortality & recurrent ischemic events like TIMI score,1 PURSUIT score,2 Framingham risk score,3 Reynolds risk score,4 HEART score & GRACE score of which GRACE risk score is more accurate.
MATERIALS AND METHODS
This study was conducted in Kanyakumari Government Medical College in the Department of General Medicine. 100 patients were included in this study over a period from August 2017-January 2018 for a period of 6 months. The details of the patient, their risk factors were noted & GRACE risk score is calculated.
RESULTS
The maximum number of cases in this study were in the age group between 60-69 years. 61% of the patients were males & 39% were females. Smoking was more prevalent in this study group with 54%, dyslipidaemia 46%, hypertension 44??, alcohol 43?? & diabetes 42??. Most of patients of NSTEMI are in low risk & STEMI are in high risk category. All the patients who expired had high Grace risk scores. Heart rate at the time of admission >110 bpm, SBP <80 mmHg, serum creatinine value >2 & KILLIP CLASS IV are associated with high mortality (p<0.01).
CONCLUSION
GRACE RISK SCORE is highly accurate in predicting in hospital mortality in patients with ACS. We should routinely use GRACE risk score in our hospital settings to identify the high-risk patients. Early invasive management should be done for patients with high scores.5