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					Online Appendix for the following [month date] JACC: Cardiovascular
Interventions article

TITLE: Reperfusion in Patients With Renal Dysfunction After
Presentation With ST-Segment Elevation or Left Bundle Branch Block
The Global Registry of Acute Coronary Events

AUTHORS: Caroline Medi, MBBS, FRACP, Gilles Montalescot, MD, PHD,
Andrzej Budaj, MD, PHD, Keith A.A. Fox, MB, CHB, FRCP, José López-
Sendón, MD, FACC, Gordon FitzGerald, PHD, David B. Brieger, MBBS,
PHD, FRACP, FACC, on behalf of the GRACE Investigators


Standardized Definitions for GRACE

ST-segment elevation myocardial infarction
New or presumed new ST-segment elevation ≥1 mm seen in any location or
new left bundle branch block on the index or qualifying electrocardiogram
with at least 1 positive cardiac biochemical marker of necrosis (including
troponin measurements, whether qualitative or quantitative).

Non–ST-segment elevation myocardial infarction
At least 1 positive cardiac biochemical marker of necrosis without new ST-
segment elevation seen on the index or qualifying electrocardiogram had to be

Unstable angina
Serum biochemical markers indicative of myocardial necrosis in each
hospital’s laboratory were within the normal range. Patients originally
admitted because of unstable angina but in whom myocardial infarction
evolved during the hospital stay were classified as having a myocardial

Myocardial infarction occurring >24 h after presentation to hospital
Elevated enzymes or cardiac markers above the diagnostic limit of the local
laboratory, with the time of the first qualifying enzymes/markers determining
the time of diagnosis. This included:

       Patients with an admission diagnosis of unstable angina that was
       converted to myocardial infarction ≥24 h after presentation

       Patients diagnosed with a myocardial infarction after coronary artery
       bypass graft surgery (CABG) or percutaneous coronary intervention
       (PCI) (and ≥24 h after presentation) as long as they qualified for
       GRACE before the intervention

       After PCI: creatine kinase (CK)-MB (or creatine phosphokinase
       [CPK]) elevation >3  upper limit of normal (ULN)
       After CABG: CK-MB (or CPK) >5  ULN

Diagnosis of a recurrent myocardial infarction confirmed by
electrocardiographic changes or elevation of cardiac markers. In patients with
acute myocardial infarction as the qualifying event, enzyme criteria for
recurrent infarction were:

   A. Re-elevation of the CK-MB to above the ULN and increase at least
   50% over the previous value

   B. If CK-MB was not available, then re-elevation of total CPK either >2 
   ULN and increase 25% over the previous value or >1.5  ULN and
   increase at least 50% over the previous value

   C. After PCI: CK-MB elevation >3  ULN and increase at least 50% over
   previous value

   D. After CABG: the criteria for recurrent infarction required both enzyme
   criteria defined in “C” and electrocardiographic changes consistent with
   myocardial infarction

Major bleeding (in-hospital)
Life-threatening bleeding requiring transfusion of ≥2 units of packed red blood
cells or resulting in an absolute decrease in hematocrit of ≥10% or death or
hemorrhagic/subdural hematoma

Congestive heart failure
Criteria same as Killip class II: bibasilar rales in ≤50% of lung fields or an S3
heart sound

Pulmonary edema
Criteria same as Killip Class III: Bibasilar rales in >50% of lung fields

Cardiac arrest/ventricular fibrillation
Rapid ventricular tachycardia with hemodynamic instability, asystole, or
electrical-mechanical dissociation requiring CPR

Stroke (embolic/ischemic, embolic with hemorrhagic conversion,
hemorrhagic or subdural hematoma, other)
Stroke-related neurological signs or symptoms (e.g., loss or slurring of speech,
altered state of consciousness); confirmed by either computed tomography or
magnetic resonance imaging

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