GRACE-RRCT
Research type
Research Study
Full title
Effectiveness of the GRACE risk score on the management and outcome of patients hospitalised with non-ST elevation acute coronary syndrome.
IRAS ID
145170
Contact name
Chris Gale
Contact email
Sponsor organisation
University of Leeds
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Research summary: Acute coronary syndrome (ACS) refers to a group of conditions due to decreased blood flow in the coronary arteries such that part of
the heart muscle is unable to function properly or dies. The term ACS refers to a spectrum of acute disorders that includes: unstable angina (UA), non ST elevation myocardial infarction (NSTEACS) and ST elevation myocardial infarction (STEMI). For acute coronary syndrome (ACS) the benefits of evidence based therapies are influenced by the patient’s baseline......Summary of results: Of the 3050 participants recruited into the trial, 2435 (~80%) participants were diagnosed with NSTEACS, 2037 (~67%) had NSTEMI and 398 (13%) had unstable angina, leaving 615 (~20%) with another diagnosis.
The team looked at 11 possible diagnostic tests or treatments that guidelines recommend people with NSTEMI or unstable angina should receive based on their level of risk. In total around 76% of patients in the whole trial received the care recommended by guidelines.
Most people in the trial were prescribed recommended drug treatments, like aspirin and other anti-clotting drugs, as well as medication to prevent another heart attack, such as statins. But only around half of people who - according to guidelines - should have had angiography (an X-ray of the coronary arteries) within 72 hours to see if there was a blockage that needed to be opened, actually had this test in the recommended time period. Overall only two thirds of people in the trial who should have been sent to cardiac rehabilitation got a referral.
Using the GRACE risk score to direct treatment did not increase the proportion of people who got guideline-recommended care for NSTEACS.
The chances of having another cardiovascular event (for example, another heart attack or a new episode of heart failure) or of dying of a cardiovascular cause within 12 months of admission were similar in both groups.
Using the GRACE risk score did not reduce the average number of days that people had to stay in hospital over the 12 month follow up period, or improve health related quality of life measured with a questionnaire.REC name
North East - Newcastle & North Tyneside 1 Research Ethics Committee
REC reference
14/NE/1180
Date of REC Opinion
6 Nov 2014
REC opinion
Further Information Favourable Opinion