Application of the Global Registry of Acute Coronary Events (GRACE) Risk Score to ACS Admissions in a Rural Hospital - A Retrospective Analysis

Zaky, F.; Brieger, David; Ryan, Mark L.; Pearson, T.

doi:10.1016/j.hlc.2016.06.067

Cited by 1 publication

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“…Our results demonstrate that in rural settings where the prevalence of anemia is likely to be high, the prognostic performance of GRACE score can be significantly improved by additively considering the presence of anemia at baseline-a simple clinical measure that can be easily implemented even in the rural settings. It is notable that very few studies [29,30] have attempted to extend the use of the GRACE score to rural settings, and those that have found a need to re-calibrate the GRACE score for such populations.…”

Section: Discussionmentioning

confidence: 99%

Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India

Chiwhane

Burchundi

Manakshe

et al. 2020

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Background: Anemia is highly prevalent in low-and middle-income countries, where prevalence of acute coronary syndrome (ACS) is also rising. Evidence indicates that baseline anemia status can prognosticate ACS. However, the Global Registry of Acute Coronary Events (GRACE) score that is popularly used all over the world does not include information on anemia. Objectives: Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS. Methods: We enrolled 200 ACS patients at the Acharya Vinoba Bhave Rural Hospital-a rural, tertiary care hospital in central India. Patients were followed for 6 months for death and major adverse cardiac event (MACE). Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI). Results: There were 31 deaths due to MACE and an additional 28 non-fatal MACE events during follow-up. Baseline hemoglobin was strongly and independently associated with both outcomes even after adjusting for a multivariable propensity score. For the outcome of death and death/MACE there was a moderate improvement in the AUC of 1% and 6%, respectively. However, for these outcomes the IDI for baseline hemoglobin was 6% (p = 0.03) and 12% (p << 0.0001), respectively, while the NRI was 0.50 (p = 0.01) and 0.78 (p << 0.0001), respectively. Conclusions: Inclusion of baseline anemia in addition to the GRACE score improves prognostication of ACS patients.

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Section: Discussionmentioning

confidence: 99%