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

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Title: Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease
Authors: Rothnie, K
Smeeth, L
Pearce, N
Herrett, E
Timmis, A
Hemingway, H
Wedzicha, J
Quint, JK
Item Type: Journal Article
Abstract: Objective To assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with COPD and to investigate how it might be improved. Methods Data were obtained on 481,849 patients with acute coronary syndrome (ACS) admitted to UK hospitals between January 2003-June 2013 from the myocardial ischaemia national audit project (MINAP) database. We compared risk of death between chronic obstructive pulmonary disease (COPD) and non-COPD patients 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. Results The risk of death after adjusting for GRACE score predicted risk of death was higher for COPD patients than for other patients (RR 1.29, 95% CI 1.28-1.33). Adding smoking into the GRACE score model did not improve accuracy for COPD patients. Either adding COPD into the model (RR 1.00, 0.94-1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96-1.01). Conclusion GRACE 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 COPD patients currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-elevation myocardial infarction or unstable angina.
Issue Date: 13-May-2016
Date of Acceptance: 22-Apr-2016
ISSN: 1468-201X
Publisher: BMJ Publishing Group
Start Page: 1442
End Page: 1448
Journal / Book Title: Heart
Volume: 102
Copyright Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:
Sponsor/Funder: GlaxoSmithKline Services Unlimited
Funder's Grant Number: PO #3000555261
Keywords: Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Open Access location:
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine

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