Modification of the Global Registry of Acute Coronary Events (GRACE) Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes
An erratum to this article was published (JAMA Cardiol, 1 Jan 2024 ↗)
Authors' conclusion
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.
Study context
- Population
- Patients with acute coronary syndromes (ACS) (Heidelberg ACS, Newcastle STEMI, SPUM-ACS cohorts), enrolled 2009–2017included
- Participants
- 9,450 patients
- Exposure
- Modified GRACE score vs original GRACE score
- Outcome
- All-cause mortality (predictive value of modified vs original GRACE score)
- Follow-up
- In-hospital, 30 days and 1 year
Methodological details3 independent cohorts, derivation and validation cohorts
- 3 independent cohorts
- Derivation and validation cohorts
Main finding
As reported in the abstract
Discrimination and reclassification, pooled population
Continuous NRI
0.097
in-hospital mortality
Continuous NRI
0.08
30-day mortality
Continuous NRI
0.056
1-year mortality
Modified GRACE
- AUC in-hospital mortality
- 0.878
- AUC 30-day mortality
- 0.858
- AUC 1-year mortality
- 0.813
Original GRACE
- AUC in-hospital mortality
- 0.780
- AUC 30-day mortality
- 0.771
- AUC 1-year mortality
- 0.797
AUC in-hospital mortality
Modified GRACE0.878
Original GRACE0.780
AUC 30-day mortality
Modified GRACE0.858
Original GRACE0.771
AUC 1-year mortality
Modified GRACE0.813
Original GRACE0.797
Observational data: associations, not effects.
Further findings
| Outcome | Modified GRACE | Original GRACE | Continuous NRI |
|---|---|---|---|
| Discrimination and reclassification, derivation cohortIn-hospital mortality | 0.208 | ||
| AUC in-hospital mortality | 0.835 | 0.741 | |
| AUC 30-day mortality | 0.828 | 0.740 | |
| AUC 1-year mortality | 0.785 | 0.778 | |
| Discrimination and reclassification, derivation cohort30-day mortality | 0.312 | ||
| Discrimination and reclassification, derivation cohort1-year mortality | 0.078 |
Discrimination and reclassification, derivation cohort
- Findings confirmed in the validation cohort
Original publication
Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes. JAMA Cardiol. Published 1 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it