Accuracy of the Global Registry of Acute Coronary Events (GRACE) Risk Score in Contemporary Treatment of Patients With Acute Coronary Syndrome

Shuvy, Mony; Beeri, Gil; Klein, Eyal; Cohen, Tal; Nir, Shlomo; Minha, Sa’ar; Pereg, David

doi:10.1016/j.cjca.2018.09.015

Cited by 40 publications

(36 citation statements)

References 18 publications

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“…GRS remains accurate for the prediction of 1-year and mid-term cardiovascular mortality under the current management of patients with STEMI, similar to a previous study [ 21 ] ;…”

Section: Discussionsupporting

confidence: 86%

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

Wang

Zhang

et al. 2020

Medicine

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There is scarce evidence that the erythrocyte sedimentation rate (ESR) could efficiently improve the prediction accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in cases of ST-elevation myocardial infarction (STEMI). A cohort of 1094 STEMI patients undergoing primary percutaneous coronary intervention was retrospectively recruited. Patients were categorized based on the ESR values. Final endpoints included cardiovascular death and major adverse cardiovascular event (MACE) occurrence. The predictive value of combined models with the GRACE score and ESR was assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement. During the mean follow-up of 23 months, 34 patients died and 190 experienced MACEs, of which 23 patients died in the first year; both endpoints were more frequent in the higher group. The ESR and high-sensitivity C-reactive protein (hs-CRP) were independent risk factors of 1-year cardiovascular death, together with the GRACE score (ESR: hazard ratio = 1.03, P = .006 hs-CRP: hazard ratio = 1.00, P = .001; GRACE: 1.03, P = .012). Although no statistical improvement in the area under the ROC curve was observed in either the GRACE/ESR or the GRACE/hs-CRP model (GRACE/ESR models: 0. 8073 vs GRACE: 0.7714, P = .22; GRACE/ESR models: 0. 7815 vs GRACE: 0.7714, P = .61), the GRACE score and ESR together significantly improved the NRI (0.633; P < .001) compared with the GRACE alone. Regarding the mid-term mortality, adding the ESR to the GRACE score not only improved the NRI (0.8433; P < .001), but also increased the integrated discrimination improvement (0.0509; P = .04). The ESR is an independent risk factor of cardiovascular death and MACE in STEMI patients receiving primary percutaneous coronary intervention. The ESR comparatively enhanced the predictive values of the prognostic model, including the GRACE risk score.

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“…GRS remains accurate for the prediction of 1-year and mid-term cardiovascular mortality under the current management of patients with STEMI, similar to a previous study [ 21 ] ;…”

Section: Discussionsupporting

confidence: 86%

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

Wang

Zhang

et al. 2020

Medicine

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“…Although the rapid development of ACS interventional, diagnostic, and treatment techniques, in addition to improvements in antithrombotic drugs over the past 15 years has led to dramatic changes in risk factors and intensity of prognosis. However, Mony et al found that the discrimination of the score was not influenced by a better outcome with latest treatment options . Our analysis further illustrated that the GRACE score may be generalized to contemporary real‐world populations in China.…”

Section: Discussionsupporting

confidence: 53%

“…However, Mony et al found that the discrimination of the score was not influenced by a better outcome with latest treatment options. 19 Our analysis further illustrated that the GRACE score may be generalized to contemporary real-world populations in China. It should be emphasized that our study had a cut-off point of 89 to calculate 2-year mortality, which is very close to the cut-off of 88 recommended in the guideline.…”

Section: Discussionmentioning

confidence: 70%

Impact of extended dual antiplatelet therapy on clinical prognosis in acute coronary syndrome patients with intermediate or high ischemic risk defined by the GRACE score

Bian

Qiu

et al. 2020

Cathet Cardio Intervent

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Objectives To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months in acute coronary syndrome (ACS) patients with intermediate‐risk to high‐risk of developing ischemia according to the Global Acute Coronary Event Registration (GRACE) score. Background The duration of optimal DAPT remains controversial in patients at higher risk of developing ischemia. Methods Overall, 9,309 ACS patients in the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT‐CAD) study were stratified as low‐risk ( n = 5,112) or intermediate‐risk to high‐risk (n = 4,197) according to the GRACE score on hospital discharge. Clinical outcomes at 12–24 months in patients with intermediate‐to‐high risk who completed 1‐year DAPT without any adverse events were analyzed. The primary endpoint was 24‐month net adverse clinical events (NACEs). Results Patients at intermediate‐to‐high‐risk had significantly higher incidence of NACE (10.2 vs. 4.9%, p < .01) and ischemic events (8.3 vs. 3.8%, p < .01) than low‐risk patients at 24 months. For patients at intermediate‐to‐high‐risk, extended DAPT beyond 12 months was associated with lower risk of NACE (3.0 vs. 5.1%, p = .012), all‐cause death (1.1 vs. 2.6%, p = .01), and cardiac death (0.6 vs. 1.8%, p = .01), without excessive risk of major bleeding events (0.3 vs. 0.5%, p = .47). Clinical outcomes in the propensity‐matched cohort were consistent. Conclusions ACS patients with intermediate‐risk or high‐ischemic risk may benefit from extended DAPT beyond 1 year, an outcome than requires further confirmation in large‐scale randomized trials.

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“…Early risk stratification and identification of high-risk patients with STEMI are of great significance in prognosis, and also in guiding diagnosis and treatment decisions (5). Currently, the Global Registry of Acute Coronary Events (GRACE) score is widely used as an acute risk stratification tool in the evaluation of prognosis in patients with acute coronary syndrome (ACS) (6). GRACE score parameters include age, systolic blood pressure, pulse, serum creatinine, Killip classification at admission, cardiac arrest at admission, markers of myocardial necrosis and changes in ST-segment (7).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the combination of GRACE risk score and mean platelet volume to lymphocyte count ratio in patients with ST‑segment elevation myocardial infarction after percutaneous coronary intervention

et al. 2020

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The Global Registry of Acute Coronary Events (GRACE) risk score and the mean platelet volume to lymphocyte count ratio (MPVLR) can be used independently to predict adverse outcomes in patients with acute coronary syndromes. However, the level of MPVLR in relation to the GRACE score, and whether a combination of these methods can better predict the clinical adverse outcome of patients with ST-segment elevation myocardial infarction (STEMI), have not been previously examined. Therefore, the aim of the present study was to investigate whether the combination of GRACE risk score and MPVLR is a good predictor of a 30-day major adverse cardiovascular events (MACE) in patients with STEMI. A total of 464 patients with STEMI undergoing percutaneous coronary intervention (PCI) were enrolled, and divided into four groups based on the optimal cutoff values for GRACE score and MPVLR. GRACE score and MPVLR levels were separately recorded during admission. Spearman's rank correlation analysis showed a positive correlation between GRACE score and MPVLR (ρ=0.304; P<0.001). Both GRACE score [hazard ratio (HR), 1.706; 95% CI, 1.435-3.058; P<0.001] and MPVLR level (HR, 1.668; 95% CI, 1.202-2.170; P<0.001) were found to be independent predictors of a 30-day MACE. Additionally, the high MPVLR + high GRACE score group of patients had an HR of 2.455 (95% CI, 1.736-3.188) for a 30-day MACE, when using the low MPVLR + low GRACE score group as a reference. Based on the area under the curve, MPVLR combined with GRACE scores achieved an improved performance in differentiating angiographic no-reflow during a 30-day MACE, compared with individual MPVLR and GRACE scores. Therefore, the present results suggested that the GRACE score may be positively correlated with MPVLR and that their combination accurately predicted the occurrence of short-term MACE in patients with STEMI after PCI.

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Accuracy of the Global Registry of Acute Coronary Events (GRACE) Risk Score in Contemporary Treatment of Patients With Acute Coronary Syndrome

Cited by 40 publications

References 18 publications

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

Impact of extended dual antiplatelet therapy on clinical prognosis in acute coronary syndrome patients with intermediate or high ischemic risk defined by the GRACE score

Prognostic value of the combination of GRACE risk score and mean platelet volume to lymphocyte count ratio in patients with ST‑segment elevation myocardial infarction after percutaneous coronary intervention

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