Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China.

Peng, Y; Du, X; Rogers, KD; Wu, Y; Gao, R; Patel, A; Clinical Pathways for Acute Coronary Syndromes in China (CPACS) Investigators,

Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China.

Peng, Y Du, X Rogers, KD Wu, Y Gao, R Patel, A Clinical Pathways for Acute Coronary Syndromes in China (CPACS) Investigators,

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: American Journal of Cardiology, 2017, 120, (7), pp. 1077-1083
Issue Date:: 2017-10-01

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Field	Value	Language
dc.contributor.author	Peng, Y
dc.contributor.author	Du, X
dc.contributor.author	Rogers, KD
dc.contributor.author	Wu, Y
dc.contributor.author	Gao, R
dc.contributor.author	Patel, A
dc.contributor.author	Clinical Pathways for Acute Coronary Syndromes in China (CPACS) Investigators,
dc.date.accessioned	2022-08-22T04:43:31Z
dc.date.available	2017-06-20
dc.date.available	2022-08-22T04:43:31Z
dc.date.issued	2017-10-01
dc.identifier.citation	American Journal of Cardiology, 2017, 120, (7), pp. 1077-1083
dc.identifier.issn	0002-9149
dc.identifier.issn	1879-1913
dc.identifier.uri	http://hdl.handle.net/10453/160679
dc.description.abstract	Currently available risk scores (RSs) were derived from populations with very few participants from China. We aimed to develop an RS based on data from patients with acute coronary syndrome in China and to compare its performance with the commonly promoted Global Registry of Acute Coronary Events (GRACE) RS. Clinical Pathways for Acute Coronary Syndromes-Phase 2 was a trial of a quality improvement intervention in China. Patients recruited from 75 hospitals from October 2007 to August 2010 were divided into training and validation sets based on immediate or delayed implementation. A Clinical Pathways for Acute Coronary Syndromes (CPACS) RS for in-hospital mortality was developed separately by gender, using the training set (6,790 patients). Discrimination and calibration of the CPACS RS and GRACE RS were compared on the validation set (3,801 patients). Although discrimination of the GRACE RS was acceptable, this was improved with the CPACS RS (c-statistic 0.82 vs 0.87, p = 0.012 for men; c-statistic 0.78 vs 0.85, p = 0.006 for women). The absolute bias was significantly lower with CPACS RS for both genders (7.6% vs 97.5% in men and 21.5% vs 77.2% in women), compared with the GRACE RS, which systematically overestimated risk. The CPACS RS underestimated risk in women, but only in those already above threshold levels currently used to define a clinical high-risk population. In conclusion, the GRACE RS substantially overestimates the risk of in-hospital death in patients presenting to the hospital with a suspected acute coronary syndrome in China. We have developed and independently validated a new RS utilizing data from Chinese patients.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	American Journal of Cardiology
dc.relation.isbasedon	10.1016/j.amjcard.2017.06.044
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology
dc.subject.classification	Cardiovascular System & Hematology
dc.subject.mesh	Acute Coronary Syndrome
dc.subject.mesh	China
dc.subject.mesh	Female
dc.subject.mesh	Hospital Mortality
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Myocardial Revascularization
dc.subject.mesh	Prognosis
dc.subject.mesh	Registries
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Risk Assessment
dc.subject.mesh	Risk Factors
dc.subject.mesh	Survival Rate
dc.subject.mesh	Acute Coronary Syndrome
dc.subject.mesh	China
dc.subject.mesh	Female
dc.subject.mesh	Hospital Mortality
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Myocardial Revascularization
dc.subject.mesh	Prognosis
dc.subject.mesh	Registries
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Risk Assessment
dc.subject.mesh	Risk Factors
dc.subject.mesh	Survival Rate
dc.subject.mesh	Humans
dc.subject.mesh	Prognosis
dc.subject.mesh	Myocardial Revascularization
dc.subject.mesh	Registries
dc.subject.mesh	Hospital Mortality
dc.subject.mesh	Survival Rate
dc.subject.mesh	Risk Assessment
dc.subject.mesh	Risk Factors
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Middle Aged
dc.subject.mesh	China
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Acute Coronary Syndrome
dc.title	Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China.
dc.type	Journal Article
utslib.citation.volume	120
utslib.location.activity	United States
utslib.for	1102 Cardiorespiratory Medicine and Haematology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-08-22T04:43:28Z
pubs.issue	7
pubs.publication-status	Published
pubs.volume	120
utslib.citation.issue	7

Abstract:

Currently available risk scores (RSs) were derived from populations with very few participants from China. We aimed to develop an RS based on data from patients with acute coronary syndrome in China and to compare its performance with the commonly promoted Global Registry of Acute Coronary Events (GRACE) RS. Clinical Pathways for Acute Coronary Syndromes-Phase 2 was a trial of a quality improvement intervention in China. Patients recruited from 75 hospitals from October 2007 to August 2010 were divided into training and validation sets based on immediate or delayed implementation. A Clinical Pathways for Acute Coronary Syndromes (CPACS) RS for in-hospital mortality was developed separately by gender, using the training set (6,790 patients). Discrimination and calibration of the CPACS RS and GRACE RS were compared on the validation set (3,801 patients). Although discrimination of the GRACE RS was acceptable, this was improved with the CPACS RS (c-statistic 0.82 vs 0.87, p = 0.012 for men; c-statistic 0.78 vs 0.85, p = 0.006 for women). The absolute bias was significantly lower with CPACS RS for both genders (7.6% vs 97.5% in men and 21.5% vs 77.2% in women), compared with the GRACE RS, which systematically overestimated risk. The CPACS RS underestimated risk in women, but only in those already above threshold levels currently used to define a clinical high-risk population. In conclusion, the GRACE RS substantially overestimates the risk of in-hospital death in patients presenting to the hospital with a suspected acute coronary syndrome in China. We have developed and independently validated a new RS utilizing data from Chinese patients.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/160679