Observational studyEuropean heart journal2018
Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction.
Observational study in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 87 citations in OpenAlex.
- Early invasive strategy for non-ST elevation acute coronary syndrome: a meta-analysis of randomized, controlled trials.The Journal of international medical research · 2020Pooled it
- Trial
- Effectiveness of GRACE risk score in patients admitted to hospital with non-ST elevation acute coronary syndrome (UKGRIS): parallel group cluster randomised controlled trial.BMJ (Clinical research ed.) · 2023Trial
- Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A Randomized Clinical Trial.JAMA cardiology · 2021Trial
- Risk Stratification in Cardiovascular Medicine for Prognostic Assessment and Therapeutic Decision-Making: From Atrial Fibrillation to the Broader Disease Spectrum.Journal of arrhythmia · 2026Review
- Non-ST-Elevation Myocardial Infarction: A Heterogeneous Syndrome with Evolving Management-A Narrative Review.Biomedicines · 2026Review
- Performance of the Grace ACS Risk Score in Predicting in-Hospital and Six-Month Mortality in Patients with ACS: A Single Center Retrospective Cohort Study.Vascular health and risk management · 2026Article
- Prognostic value of GRACE and EDACS scores in non-STEMI patients presenting to the emergency department.Open medicine (Warsaw, Poland) · 2026Article
- Outcomes of NSTEMI Admissions and Significance of TIMI Scores: A Nationwide Analysis Using the National Inpatient Sample.Journal of clinical medicine · 2024Article
- Validation of machine learning-based risk stratification scores for patients with acute coronary syndrome treated with percutaneous coronary intervention.European heart journal. Digital health · 2024Article
- Cardiac ultrasomics for acute myocardial infarction risk stratification and prediction of all-cause mortality: a feasibility study.Echo research and practice · 2024Article
- Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in The Era of High-Sensitivity Cardiac Troponin.Global heart · 2024Article
- Identification of Potential Crucial Biomarkers in STEMI Through Integrated Bioinformatic Analysis.Arquivos brasileiros de cardiologia · 2024Article
- Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology.European heart journal. Quality of care & clinical outcomes · 2023Article
- Identification of Low- versus High-Risk Acute Coronary Syndrome for a Selective ECG Monitoring Strategy.Journal of clinical medicine · 2023Article
- Article
- External validation of the GRACE risk score and the risk-treatment paradox in patients with acute coronary syndrome.Open heart · 2022Article
- Use of Lipid-, Blood Pressure-, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease.JAMA network open · 2022Article
- Age-adjusted interpretation of biomarkers of renal function and homeostasis, inflammation, and circulation in Emergency Department patients.Scientific reports · 2022Observational
- Comparison of GRACE and TIMI risk scores in the prediction of in-hospital and long-term outcomes among East Asian non-ST-elevation myocardial infarction patients.BMC cardiovascular disorders · 2022Observational
Corrections and comments
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Authors and funding
14 authors at 9 institutions in 4 countries.
Funding
Abstract
Aims: To investigate whether improved survival from non-ST-elevation myocardial infarction (NSTEMI), according to GRACE risk score, was associated with guideline-indicated treatments and diagnostics, and persisted after hospital discharge. Methods and results: National cohort study (n = 389 507 patients, n = 232 hospitals, MINAP registry), 2003-2013. The primary outcome was adjusted all-cause survival estimated using flexible parametric survival modelling with time-varying covariates. Optimal care was defined as the receipt of all eligible treatments and was inversely related to risk status (defined by the GRACE risk score): 25.6% in low, 18.6% in intermediate, and 11.5% in high-risk NSTEMI. At 30 days, the use of optimal care was associated with improved survival among high [adjusted hazard ratio (aHR) -0.66 95% confidence interval (CI) 0.53-0.86, difference in absolute mortality rate (AMR) per 100 patients (AMR/100-0.19 95% CI -0.29 to -0.08)], and intermediate (aHR = 0.74, 95% CI 0.62-0.92; AMR/100 = -0.15, 95% CI -0.23 to -0.08) risk NSTEMI. At the end of follow-up (8.4 years, median 2.3 years), the significant association between the use of all eligible guideline-indicated treatments and improved survival remained only for high-risk NSTEMI (aHR = 0.66, 95% CI 0.50-0.96; AMR/100 = -0.03, 95% CI -0.06 to -0.01). For low-risk NSTEMI, there was no association between the use of optimal care and improved survival at 30 days (aHR = 0.92, 95% CI 0.69-1.38) and at 8.4 years (aHR = 0.71, 95% CI 0.39-3.74). Conclusion: Optimal use of guideline-indicated care for NSTEMI was associated with greater survival gains with increasing GRACE risk, but its use decreased with increasing GRACE risk.
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Registered trials
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