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Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes

The Global Registry of Acute Coronary Events (GRACE) risk score, a guideline-recommended risk stratification tool for patients presenting with acute coronary syndromes (ACS), does not consider the extent of myocardial injury.To assess the incremental predictive value of a modified GRACE score incorp...

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Main Authors: Georgiopoulos, Georgios (Author) , Kraler, Simon (Author) , Mueller-Hennessen, Matthias (Author) , Delialis, Dimitrios (Author) , Mavraganis, Georgios (Author) , Sopova, Kateryna (Author) , Wenzl, Florian A. (Author) , Räber, Lorenz (Author) , Biener, Moritz (Author) , Stähli, Barbara E. (Author) , Maneta, Eleni (Author) , Spray, Luke (Author) , Iglesias, Juan F. (Author) , Coelho-Lima, Jose (Author) , Tual-Chalot, Simon (Author) , Muller, Olivier (Author) , Mach, François (Author) , Frey, Norbert (Author) , Dürschmied, Daniel (Author) , Langer, Harald (Author) , Katus, Hugo (Author) , Roffi, Marco (Author) , Camici, Giovanni G. (Author) , Mueller, Christian (Author) , Giannitsis, Evangelos (Author) , Spyridopoulos, Ioakim (Author) , Lüscher, Thomas F. (Author) , Stellos, Konstantinos (Author) , Stamatelopoulos, Kimon (Author)
Format: Article (Journal)
Language:English
Published: August 30, 2023
In: JAMA cardiology
Year: 2023, Volume: 8, Issue: 10, Pages: 946-956
ISSN:2380-6591
DOI:10.1001/jamacardio.2023.2741
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1001/jamacardio.2023.2741
Verlag, lizenzpflichtig, Volltext: https://jamanetwork.com/journals/jamacardiology/fullarticle/2809088
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Author Notes:Georgios Georgiopoulos, MD; Simon Kraler, MD; Matthias Mueller-Hennessen, MD; Dimitrios Delialis, MD; Georgios Mavraganis, MD; Kateryna Sopova, MD; Florian A. Wenzl, MD; Lorenz Räber, MD; Moritz Biener, MD; Barbara E. Stähli, MD; Eleni Maneta, MD; Luke Spray, MD; Juan F. Iglesias, MD; Jose Coelho-Lima, MD, PhD; Simon Tual-Chalot, PhD; Olivier Muller, MD, PhD; François Mach, MD; Norbert Frey, MD; Daniel Duerschmied, MD; Harald F. Langer, MD; Hugo Katus, MD; Marco Roffi, MD; Giovanni G. Camici, PhD; Christian Mueller, MD; Evangelos Giannitsis, MD; Ioakim Spyridopoulos, MD; Thomas F. Lüscher, MD; Konstantinos Stellos, MD; Kimon Stamatelopoulos, MD
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Summary:The Global Registry of Acute Coronary Events (GRACE) risk score, a guideline-recommended risk stratification tool for patients presenting with acute coronary syndromes (ACS), does not consider the extent of myocardial injury.To assess the incremental predictive value of a modified GRACE score incorporating high-sensitivity cardiac troponin (hs-cTn) T at presentation, a surrogate of the extent of myocardial injury.This retrospectively designed longitudinal cohort study examined 3 independent cohorts of 9803 patients with ACS enrolled from September 2009 to December 2017; 2 ACS derivation cohorts (Heidelberg ACS cohort and Newcastle STEMI cohort) and an ACS validation cohort (SPUM-ACS study). The Heidelberg ACS cohort included 2535 and the SPUM-ACS study 4288 consecutive patients presenting with a working diagnosis of ACS. The Newcastle STEMI cohort included 2980 consecutive patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Data were analyzed from March to June 2023.In-hospital, 30-day, and 1-year mortality risk estimates derived from an updated risk score that incorporates continuous hs-cTn T at presentation (modified GRACE).The predictive value of continuous hs-cTn T and modified GRACE risk score compared with the original GRACE risk score. Study end points were all-cause mortality during hospitalization and at 30 days and 1 year after the index event.Of 9450 included patients, 7313 (77.4%) were male, and the mean (SD) age at presentation was 64.2 (12.6) years. Using continuous rather than binary hs-cTn T conferred improved discrimination and reclassification compared with the original GRACE score (in-hospital mortality: area under the receiver operating characteristic curve [AUC], 0.835 vs 0.741; continuous net reclassification improvement [NRI], 0.208; 30-day mortality: AUC, 0.828 vs 0.740; NRI, 0.312; 1-year mortality: AUC, 0.785 vs 0.778; NRI, 0.078) in the derivation cohort. These findings were confirmed in the validation cohort. In the pooled population of 9450 patients, modified GRACE risk score showed superior performance compared with the original GRACE risk score in terms of reclassification and discrimination for in-hospital mortality end point (AUC, 0.878 vs 0.780; NRI, 0.097), 30-day mortality end point (AUC, 0.858 vs 0.771; NRI, 0.08), and 1-year mortality end point (AUC, 0.813 vs 0.797; NRI, 0.056).In this study, using continuous rather than binary hs-cTn T at presentation, a proxy of the extent of myocardial injury, in the GRACE risk score improved the mortality risk prediction in patients with ACS.
Item Description:Gesehen am 12.08.2024
Physical Description:Online Resource
ISSN:2380-6591
DOI:10.1001/jamacardio.2023.2741

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