American Heart Journal
Volume 158, Issue 3 , Pages 392-399 , September 2009

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

  • Basem Elbarouni, MD

      Affiliations

    • University of Michigan Health System, Ann Arbor, MI
  • ,
  • Shaun G. Goodman, MD, MSc

      Affiliations

    • University of Michigan Health System, Ann Arbor, MI
    • The Canadian Heart Research Centre, Toronto, Ontario, Canada
  • ,
  • Raymond T. Yan, MD

      Affiliations

    • University of Michigan Health System, Ann Arbor, MI
  • ,
  • Robert C. Welsh, MD

      Affiliations

    • University of Alberta, Edmonton, Alberta, Canada
  • ,
  • Jan M. Kornder, MD

      Affiliations

    • Surrey Memorial Hospital, Surrey, British Columbia, Canada
  • ,
  • J. Paul DeYoung, MD

      Affiliations

    • Cornwall Community Hospital, Cornwall, Ontario, Canada
  • ,
  • Graham C. Wong, MD

      Affiliations

    • University of British Columbia, Vancouver, British Columbia, Canada
  • ,
  • Barry Rose, MD

      Affiliations

    • Health Sciences Centre, St John's, Newfoundland, Canada
  • ,
  • François R. Grondin, MD

      Affiliations

    • Hotel-Dieu de Levis, Levis, Quebec, Canada
  • ,
  • Richard Gallo, MD

      Affiliations

    • Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • Mary Tan, BSc

      Affiliations

    • The Canadian Heart Research Centre, Toronto, Ontario, Canada
  • ,
  • Amparo Casanova, MD, PhD

      Affiliations

    • The Canadian Heart Research Centre, Toronto, Ontario, Canada
  • ,
  • Kim A. Eagle, MD

      Affiliations

    • University of Michigan Health System, Ann Arbor, MI
  • ,
  • Andrew T. Yan, MD

      Affiliations

    • Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • The Canadian Heart Research Centre, Toronto, Ontario, Canada
    • Corresponding Author InformationReprint requests: Andrew T. Yan, MD, is to be contacted at Division of Cardiology, St Michael's Hospital, 30 Bond Street, Room 6-030 Queen, Toronto, Ontario, Canada M5B 1W8. Shaun G. Goodman, Division of Cardiology, St Michael's Hospital, 30 Bond Street, Room 6-034 Queen, Toronto, Ontario, Canada M5B 1W8.
  • ,
  • on behalf of the Canadian Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators

Received 10 March 2009 ,Accepted 2 June 2009.

References 

  1. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1–e157
  2. Bhatt DL, Roe MT, Peterson ED, Li Y, Chen AY, Harrington RA, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004;292:2096–2104
  3. Yan RT, Yan AT, Tan M, et al. Underuse of evidence-based treatment partly explains the worse clinical outcome in diabetic patients with acute coronary syndromes. Am Heart J. 2006;152:676–683
  4. Collinson J, Flather MD, Fox KA, et al. Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK). Eur Heart J. 2000;21:1450–1457
  5. Oliveira GB, Avezum A, Anderson FA, et al. Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification. Am Heart J. 2007;153:493–499
  6. Roe MT, Peterson ED, Newby LK, et al. The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2006;151:1205–1213
  7. Tricoci P, Peterson ED, Mulgund J, et al. Temporal trends in the use of early cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes (results from CRUSADE). Am J Cardiol. 2006;98:1172–1176
  8. Yan AT, Yan RT, Tan M, et al. Management patterns in relation to risk stratification among patients with non-ST elevation acute coronary syndromes. Arch Intern Med. 2007;167:1009–1016
  9. Yan AT, Yan RT, Huynh T, et al. Understanding physicians' risk stratification of acute coronary syndromes: insights from the Canadian ACS 2 Registry. Arch Intern Med. 2009;169:372–378
  10. Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345–2353
  11. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation. 2000;101:2557–2567
  12. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835–842
  13. Yan AT, Jong P, Yan RT, et al. Clinical trial–derived risk model may not generalize to real-world patients with acute coronary syndrome. Am Heart J. 2004;148:1020–1027
  14. de Araujo Goncalves P, Ferreira J, Aguiar C, et al. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J. 2005;26:865–872
  15. Lyon R, Morris AC, Caesar D, et al. Chest pain presenting to the emergency department—to stratify risk with GRACE or TIMI?. Resuscitation. 2007;74:90–93
  16. Ramsay G, Podogrodzka M, McClure C, et al. Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. QJM. 2007;100:11–18
  17. Yan AT, Yan RT, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J. 2007;28:1072–1078
  18. Gale CP, Manda SO, Weston CF, et al. Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database. Heart. 2009;95:221–227
  19. Fox KA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA. 2007;297:1892–1900
  20. Jeger RV, Radovanovic D, Hunziker PR, et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008;149:618–626
  21. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001;141:190–199
  22. GRACE risk score. Available at http://www.outcomes-umassmed.org/GRACE/acs_risk.cfmLast accessed January 26, 2009
  23. Weintraub WS. Prediction scores after myocardial infarction: value, limitations, and future directions. Circulation. 2002;106:2292–2293
  24. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36
  25. Lemeshow S, Hosmer DWJ. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92–106
  26. Fox KA, Anderson FA, Dabbous OH, et al. Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE). Heart. 2007;93:177–182
  27. Hordijk-Trion M, Lenzen M, Wijns W, et al. Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization. Eur Heart J. 2006;27:671–678
  28. Bahit MC, Cannon CP, Antman EM, et al. Direct comparison of characteristics, treatment, and outcomes of patients enrolled versus patients not enrolled in a clinical trial at centers participating in the TIMI 9 Trial and TIMI 9 Registry. Am Heart J. 2003;145:109–117
  29. Gulati M, Patel S, Jaffe AS, et al. Impact of contemporary guideline compliance on risk stratification models for acute coronary syndromes in The Registry of Acute Coronary Syndromes. Am J Cardiol. 2004;94:873–878
  30. Fox KAA, Goodman SG, Anderson FA, et al. From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes: The Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1414–1424
  31. Fox KAA, Goodman SG, Klein W, et al. Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2002;23:1177–1189
  32. Mahaffey KW, Yang Q, Pieper KS, et al. Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial. J Gen Intern Med. 2008;23:310–316
  33. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291:2727–2733
  34. Bradshaw PJ, Ko DT, Newman AM, et al. Validity of the GRACE (Global Registry of Acute Coronary Events) acute coronary syndrome prediction model for six month post-discharge death in an independent data set. Heart. 2006;92:905–909
  35. Alter DA, Venkatesh V, Chong A. Evaluating the performance of the Global Registry of Acute Coronary Events risk-adjustment index across socioeconomic strata among patients discharged from the hospital after acute myocardial infarction. Am Heart J. 2006;151:323–331

PII: S0002-8703(09)00452-9

doi: 10.1016/j.ahj.2009.06.010

American Heart Journal
Volume 158, Issue 3 , Pages 392-399 , September 2009