Evidence map›Paper›PMID 27177534›Full record

ArticleHeart (British Cardiac Society)2016

Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease.

Kieran J Rothnie, Liam Smeeth, Neil Pearce, Emily Herrett, Adam Timmis, Harry Hemingway, Jadwiga Wedzicha, Jennifer K Quint

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart (British Cardiac Society), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Kieran J RothnieRespiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.ORCID 0000-0003-4279-1624
Liam SmeethFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Farr Institute of Health Informatics Research, London, UK.
Neil PearceFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Emily HerrettFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Adam TimmisFarr Institute of Health Informatics Research, London, UK Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK.
Harry HemingwayFarr Institute of Health Informatics Research, London, UK Department of Epidemiology and Public Health, University College London, London, UK.
Jadwiga WedzichaAirway Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Jennifer K QuintRespiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

Funding

British Heart FoundationCancer Research UKMedical Research Council G0902135Medical Research Council MR/K006584/1Wellcome TrustWellcome Trust 086091/Z/08/Z
6 · The paper itself

Abstract

objectiveTo assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with chronic obstructive pulmonary disease (COPD) and to investigate how it might be improved.

methodsData were obtained on 481 849 patients with acute coronary syndrome admitted to UK hospitals between January 2003 and June 2013 from the Myocardial Ischaemia National Audit Project (MINAP) database. We compared risk of death between patients with COPD and those without COPD at 6 months, adjusting for predicted risk of death. We then assessed whether several modifications improved the accuracy of the GRACE score for people with COPD.

resultsThe risk of death after adjusting for GRACE score predicted that risk of death was higher for patients with COPD than that for other patients (RR 1.29, 95% CI 1.28 to 1.33). Adding smoking into the GRACE score model did not improve accuracy for patients with COPD. Either adding COPD into the model (relative risk (RR) 1.00, 0.94 to 1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96 to 1.01).

conclusionsGRACE scores underestimate risk of death for people with COPD. A more accurate prediction of risk of death can be obtained by adding COPD into the GRACE score equation, or by multiplying the GRACE score predicted risk of death by 1.3 for people with COPD. This means that one third of patients with COPD currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-segment elevation myocardial infarction or unstable angina.

Indexed as

Decision Support TechniquesAcute Coronary SyndromeAgedAged, 80 and overAngina, UnstableEnglandFemaleHumansLogistic ModelsMaleMiddle AgedNon-ST Elevated Myocardial InfarctionOdds RatioPredictive Value of TestsPrognosisPulmonary Disease, Chronic Obstructive

Identifiers

PMID27177534
PMCPMC5013109

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.