Modern NCDR and ACTION risk models outperform the GRACE model for prediction of in-hospital mortality in acute coronary syndrome in a German cohort

Performance of the Risk Scores for Predicting In-Hospital Mortality in Patients with Acute Coronary Syndrome in a Chinese Cohort

“…In the Spanish cohort, both ACTION and GRACE showed proper distinctions between in-hospital deaths (C statistics were 0.90 and 0.90, respectively) and had good calibration (Hosmer-Lemeshow goodness of fit test values 0.50 and 0.47, respectively) [20]. In the German cohort, Parco et al [10] evaluated the predictive efficacy of the ACTION model, including 1567 (non) ST-segment elevation myocardial infarction patients who received invasive treatment at Düsseldorf University Hospital in Germany from 2014 to 2018. The results showed that the performance of the ACTION and GRACE risk models are com-parable (c-index 0.84, p GRACE vs. ACTION = 0.68), with an advantage in for the ACTION model in NSTEMI patients (cindex 0.87 [ACTION] vs. 0.84 [GRACE]; p GRACE vs. ACTION = 0.02) [10].…”

“…In the German cohort, Parco et al [10] evaluated the predictive efficacy of the ACTION model, including 1567 (non) ST-segment elevation myocardial infarction patients who received invasive treatment at Düsseldorf University Hospital in Germany from 2014 to 2018. The results showed that the performance of the ACTION and GRACE risk models are com-parable (c-index 0.84, p GRACE vs. ACTION = 0.68), with an advantage in for the ACTION model in NSTEMI patients (cindex 0.87 [ACTION] vs. 0.84 [GRACE]; p GRACE vs. ACTION = 0.02) [10]. A key distinguishing feature of ACTION from TIMI and GRACE scores is its ability to better differentiate high-risk patients when included after cardiac arrest, in cardiogenic shock, and in HF.…”

“…The GRACE study is currently the world’s first prospective prediction study of all types of unscreened ACS patients conducted in multiple countries [ 4 , 12 ]. Extensive external verifications have confirmed the value of GRACE in assessing early and delayed invasive management strategies in ACS, and it has been recommended by the ESC and AHA guidelines [ 1 , 2 , 10 , 13 , 14 , 15 , 16 , 17 ]. The updated version of the GRACE 2.0 model, released in 2016, introduced nonlinear association and improved bedside ease of use through mobile phone software [ 5 ].…”

“…The acute coronary treatment and intervention outcomes network (ACTION) risk model has been recently developed and validated for ACS patient management [ 8 , 9 ]. However, only a few studies have conducted external verification of this model [ 10 ]. Finally, a model from clinical pathways for acute coronary syndromes (CPACS) has been designed specifically for Chinese ACS patients [ 11 ].…”

External validation of the GRACE risk score in patients with myocardial infarction in Hungary

“…Several studies have compared different prognostic scores. Parco et al [15] compared the GRACE risk score, Acute Coronary Treatment and Interventions Outcomes Network (ACTION), and National Cardiovascular Data (NCDR) risk models and found that ACTION and NCDR were more effective than GRACE risk score in predicting in-hospital mortality. In the case of ST-elevation myocardial infarction TIMI (thrombolysis in myocardial infarction), CADILLAC (controlled abciximab and device investigation to lower late angioplasty complications), and GRACE risk score, all three prognostic scores were excellent in predicting 30-day and one-year mortality [16] .…”