TY - JOUR T1 - THE STORM (acute coronary Syndrome in paTients end Of life and Risk assesMent) study JF - Emergency Medicine Journal JO - Emerg Med J SP - 10 LP - 16 DO - 10.1136/emermed-2014-204114 VL - 33 IS - 1 AU - Claudio Moretti AU - Giorgio Quadri AU - Fabrizio D'Ascenzo AU - Maurizio Bertaina AU - Federico Giusto AU - Sebastiano Marra AU - Corrado Moiraghi AU - Luca Scaglione AU - Mauro Torchio AU - Giuseppe Montrucchio AU - Mario Bo AU - Massimo Porta AU - Paolo Cavallo Perin AU - Carlo Marinone AU - Franco Riccardini AU - Javaid Iqbal AU - Pierluigi Omedè AU - Serena Bergerone AU - Franco Veglio AU - Fiorenzo Gaita Y1 - 2016/01/01 UR - http://emj.bmj.com/content/33/1/10.abstract N2 - Introduction Elderly patients with coexisting frailty and multiple comorbidities frequently present to the emergency department (ED). Because non-cardiovascular comorbidities and declining health status may affect their life expectancy, management of these patients should start in the ED. This study evaluated the role of Gold Standards Framework (GSF) criteria for identifying patients with acute coronary syndromes (ACS) approaching end of life.Methods All consecutive patients admitted to the ED and hospitalised with a diagnosis of ACS between May 2012 and July 2012 were included. According to GSF criteria, patients were labelled as positive GSF status when they met at least one general criterion and two heart disease criteria; furthermore, traditional cardiovascular risk scores (the Global Registry for Acute Coronary Events (GRACE) score and the Age, Creatinine and Ejection Fraction (ACEF) score) were calculated and WHOQOL-BREF was assessed. Mortality and repeat hospitalisation due to cardiovascular and non-cardiovascular causes were evaluated at 3-month and 12-month follow-up.Results From a total of 156 patients with ACS enrolled, 22 (14%) had a positive GSF. A positive GSF was associated with higher rate of non-cardiovascular events (22.7% vs 6.7%; p=0.03) at 3 months and higher rates of both cardiovascular and non-cardiovascular events (36% vs 16.4%; p=0.04 and 27.3% vs 6.7%; p=0.009, respectively) at 12 months. In multivariate analysis, an in-hospital GRACE score was a predictor of cardiovascular events, while a positive GSF independently predicted non-cardiovascular events.Conclusions The GSF score independently predicts non-cardiovascular events in patients presenting with ACS and may be used along with traditional cardiovascular risk scores in choosing wisely the most appropriate treatment. The present results need to be externally validated on larger samples. ER -