Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada

Elbarouni, Basem; Goodman, Shaun G.; Yan, Raymond T.; Welsh, Robert C.; Kornder, Jan M.; DeYoung, J. Paul; Wong, Graham C.; Rose, Barry; Grondin, François; Gallo, Richard; Tan, Mary; Casanova, Amparo; Eagle, Kim A.; Yan, Andrew T.; Investigators, Grace

doi:10.1016/j.ahj.2009.06.010

Cited by 177 publications

(108 citation statements)

References 34 publications

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“…Finally, we evaluated whether FI is a predictor of 6‐month all‐cause and cardiac‐specific mortality. Multivariable logistic regression models were used to estimate the marginal effect of FI separately by MI type (NSTEMI and STEMI) after adjusting for sex and GRACE (Global Registry of Acute Coronary Events) risk score 13, 14. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported per 0.1 FI.…”

Section: Methodsmentioning

confidence: 99%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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Section: Methodsmentioning

confidence: 99%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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“…10,11 Nevertheless, prognostic assessment of patients with an MI is still an area of ongoing research. Although the scores that have been developed are extremely useful for the prognostication of these patients and the validity of the GRACE score in particular is well established, [12][13][14] better statistical approaches and scores more efficient in low-and high-risk patient stratification should be developed, considering early risk stratification plays a pivotal role in patients with MI. As these scores and approaches are developed, they need to be validated and tested for discrimination and calibration.…”

Section: Introductionmentioning

confidence: 99%

ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

Barra¹,

Providência²,

Paiva³

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Thrombolysis In Myocardial Infarction (TIMI), Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin (PURSUIT) and Global Registry of Acute Coronary Events (GRACE) scores have been developed for risk stratification in myocardial infarction (MI). The latter is the most validated score, yet active research is ongoing for improving prognostication in MI. Aim: Derivation and validation of a new model for intrahospital, post-discharge and combined/total all-cause mortality prediction -ACHTUNG-Rule -and comparison with the GRACE algorithm. Methods: 1091 patients admitted for MI (age 68.4 ± 13.5, 63.2% males, 41.8% acute MI with ST-segment elevation (STEMI)) and followed for 19.7 ± 6.4 months were assigned to a derivation sample. 400 patients admitted at a later date at our institution (age 68.3 ± 13.4, 62.7% males, 38.8% STEMI) and followed for a period of 7.2 ± 4.0 months were assigned to a validation sample. Three versions of the ACHTUNG-Rule were developed for the prediction of intrahospital, postdischarge and combined (intrahospital plus post-discharge) all-cause mortality prediction. All models were evaluated for their predictive performance using the area under the receiver operating characteristic (ROC) curve, calibration through the Hosmer-Lemeshow test and predictive utility within each individual patient through the Brier score. Comparison through ROC curve analysis and measures of risk reclassification -net reclassification improvement index (NRI) or Integrated Discrimination Improvement (IDI) -was performed between the ACHTUNG versions for intrahospital, postdischarge and combined mortality prediction and the equivalent GRACE score versions for intrahospital (GRACE-IH), post-discharge (GRACE-6PD) and post-admission 6-month mortality (GRACE-6). Results: Assessment of calibration and overall performance of the ACHTUNG-Rule demonstrated a good fit (p value for the Hosmer-Lemeshow goodness-of-fit test of 0.258, 0.101 and 0.550 for ACHTUNG-IH, ACHTUNG-T and ACHTUNG-R, respectively) and high discriminatory power in the validation cohort for all the primary endpoints (intrahospital mortality: AUC ACHTUNG-IH 0.886 ± 0.035 vs. AUC GRACE-IH 0.906 ± 0.026; post-discharge mortality: AUC ACHTUNG-R 0.827 ± 0.036 vs. AUC GRACE-6PD 0.811 ± 0.034; combined/total mortality: AUC ACHTUNG-T 0.831 ± 0.028 vs. AUC GRACE-6 0.815 ± 0.033). Furthermore, all versions of the ACHTUNG-Rule accurately reclassified a significant number of patients in different, more appropriate, risk categories (NRI ACHTUNG-IH 17.1%, p (2-sided) = 0.0021; NRI ACHTUNG-R 22.0%, p = 0.0002; NRI ACHTUNG-T 18.6%, p = 0.0012). The prognostic performance of the ACHTUNG-Rule was similar in both derivation and validation samples. Conclusions: All versions of the ACHTUNG-Rule have shown excellent discriminative power and good calibration for predicting intrahospital, post-discharge and combined in-hospital plus post-discharge mortality. The ACHTUNG version for intrahospital mortality prediction was not inferior...

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“…[32] Taken together, the slight imprecise prediction of in-hospital mortality probability in men may warrant future recalibration in face of evolving improvements in treatments and patient outcomes.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome

Gong

Goodman

Brieger

et al. 2017

International Journal of Cardiology

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Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada

Cited by 177 publications

References 34 publications

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome

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