Clinical Investigation
Acute Ischemic Heart Disease
Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome

https://doi.org/10.1016/j.ahj.2006.10.004Get rights and content

Background

The Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score (GRACE score) developed from a multinational registry involving all subsets of acute coronary syndrome (ACS) predicted 6-month survival. There is currently no validated risk model to predict mortality beyond 6 months.

Methods and Results

Of the 1143 consecutive patients with ACS admitted to coronary care unit in 2000 to 2002 (mean age, 64.9 ± 12.6 years), 39% had ST-elevation myocardial infarction, 39% had non–ST-elevation infarction, and 22% had unstable angina. The mortality was 7.5% during index admission, 12.1% at 6 months, 14.8% at 1 year, 18.7% at 2 years, 25.0% at 3 years, and 39.2% at 4 years. The GRACE hospital discharge risk score calculated for 1057 hospital survivors discriminated survival from death at 6 months (C index, 0.81), 1 year (C index, 0.82), 2 years (C index, 0.81), 3 years (C index, 0.81), and 4 years (C index, 0.80). The risk score worked for all 3 subsets of ACS at all time points, with C index >0.75 in all analyses. A separate multivariable mortality model for these 1057 patients over the 4-years follow-up period identified 10 independent predictors of mortality. Seven were in the GRACE risk model (age, history of ischemic heart disease, heart failure, increased heart rate on admission, serum creatinine level, evidence of myonecrosis, not receiving in-hospital percutaneous coronary intervention).

Conclusions

The GRACE postdischarge risk score contains relevant prognostic factors and accurately discriminate survivors from nonsurvivors over the longer term (up to 4 years) in all subsets of ACS patients.

Section snippets

Methods

This is a retrospective study including consecutive patients with ACS admitted into 2 related centers in New Zealand, including the tertiary teaching hospital in Dunedin, Otago, and the regional hospital in Invercargill, Southland, from the years 2000 to 2002. Patients having ACS precipitated by significant noncardiac comorbidity, trauma, or surgery were excluded. This study protocol was in accordance with the local hospital research guidelines.

All clinical data were collected by a research

Patients

A total of 1143 consecutive patients with ACS (mean age, 64.9 ± 12.6 years) including 446 (39.0%) with STEMI, 450 (39.4%) with NSTEMI, and 247 (21.6%) with unstable angina were studied. Among them, 1057 (92.5%) survived hospital admission. The mortality of the 1143 patients was 7.5% in-hospital during index admission, 12.1% at 6 months, 14.8% at 1 year, 18.7% at 2 years, 25.0% at 3 years, and 39.2% at 4 years.

This study focused on the 1057 hospital survivors. Their demographic characteristics,

Discussion

This is the first time the GRACE hospital discharge risk score has been independently shown to accurately discriminate survivors from nonsurvivors at different time points up to 4 years in a separate cohort of consecutive patients with ACS. Of note, the mortality discrimination is observed in all 3 subsets of ACS (STEMI, NSTEMI, and unstable angina) at multiple time points from 6 months to 4 years with a C index of >0.75.

To ascertain the accuracy of a prediction model, the classical method is

Conclusion

The GRACE 6-month all-cause mortality risk model can accurately discriminate survivors from nonsurvivors in all subsets of ACS for up to 4 years.

References (17)

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Doctor E.W. Tang received support from The Cardiac Society of Australia and New Zealand/MSD Fellowship.

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