Clinical InvestigationAcute Ischemic Heart DiseaseGlobal Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome
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.
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Doctor E.W. Tang received support from The Cardiac Society of Australia and New Zealand/MSD Fellowship.