“Do GRACE (Global Registry of Acute Coronary events) risk scores still maintain their performance for predicting mortality in the era of contemporary management of acute coronary syndromes?”

Abu-Assi, Emad; Ferreira‐González, Ignacio; Ribera, Aída; Marsal, Josep Ramón; Cascant, Purificación; Heras, Magda; Bueno, Héctor; Sánchez, Pedro L.; Arós, Fernando; Marrugat, Jaume; Garcı́a-Dorado, David; Peña-Gil, Carlos; González-Juanatey, José Ramón; Permanyer-Miralda, Gaietà

doi:10.1016/j.ahj.2010.06.053

Cited by 67 publications

(50 citation statements)

References 25 publications

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“…When needed, baseline characteristics are described with mean ± standard deviation for continuous data and counts and proportions for categorical data. Patients' baseline characteristics were used for determining their risk classification according to published criteria for GRACE: 16,17 1. For patients with non ST segment elevation MI (NSTEMI), a GRACE-IH score below 109 was considered low risk, whereas scores between 109 and 140 and above 140 were assigned to intermediate-and high-risk categories, respectively.…”

Section: Discussionmentioning

confidence: 99%

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ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

Barra¹,

Providência²,

Paiva³

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Thrombolysis In Myocardial Infarction (TIMI), Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin (PURSUIT) and Global Registry of Acute Coronary Events (GRACE) scores have been developed for risk stratification in myocardial infarction (MI). The latter is the most validated score, yet active research is ongoing for improving prognostication in MI. Aim: Derivation and validation of a new model for intrahospital, post-discharge and combined/total all-cause mortality prediction -ACHTUNG-Rule -and comparison with the GRACE algorithm. Methods: 1091 patients admitted for MI (age 68.4 ± 13.5, 63.2% males, 41.8% acute MI with ST-segment elevation (STEMI)) and followed for 19.7 ± 6.4 months were assigned to a derivation sample. 400 patients admitted at a later date at our institution (age 68.3 ± 13.4, 62.7% males, 38.8% STEMI) and followed for a period of 7.2 ± 4.0 months were assigned to a validation sample. Three versions of the ACHTUNG-Rule were developed for the prediction of intrahospital, postdischarge and combined (intrahospital plus post-discharge) all-cause mortality prediction. All models were evaluated for their predictive performance using the area under the receiver operating characteristic (ROC) curve, calibration through the Hosmer-Lemeshow test and predictive utility within each individual patient through the Brier score. Comparison through ROC curve analysis and measures of risk reclassification -net reclassification improvement index (NRI) or Integrated Discrimination Improvement (IDI) -was performed between the ACHTUNG versions for intrahospital, postdischarge and combined mortality prediction and the equivalent GRACE score versions for intrahospital (GRACE-IH), post-discharge (GRACE-6PD) and post-admission 6-month mortality (GRACE-6). Results: Assessment of calibration and overall performance of the ACHTUNG-Rule demonstrated a good fit (p value for the Hosmer-Lemeshow goodness-of-fit test of 0.258, 0.101 and 0.550 for ACHTUNG-IH, ACHTUNG-T and ACHTUNG-R, respectively) and high discriminatory power in the validation cohort for all the primary endpoints (intrahospital mortality: AUC ACHTUNG-IH 0.886 ± 0.035 vs. AUC GRACE-IH 0.906 ± 0.026; post-discharge mortality: AUC ACHTUNG-R 0.827 ± 0.036 vs. AUC GRACE-6PD 0.811 ± 0.034; combined/total mortality: AUC ACHTUNG-T 0.831 ± 0.028 vs. AUC GRACE-6 0.815 ± 0.033). Furthermore, all versions of the ACHTUNG-Rule accurately reclassified a significant number of patients in different, more appropriate, risk categories (NRI ACHTUNG-IH 17.1%, p (2-sided) = 0.0021; NRI ACHTUNG-R 22.0%, p = 0.0002; NRI ACHTUNG-T 18.6%, p = 0.0012). The prognostic performance of the ACHTUNG-Rule was similar in both derivation and validation samples. Conclusions: All versions of the ACHTUNG-Rule have shown excellent discriminative power and good calibration for predicting intrahospital, post-discharge and combined in-hospital plus post-discharge mortality. The ACHTUNG version for intrahospital mortality prediction was not inferior...

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Section: Discussionmentioning

confidence: 99%

“…The original GRACE score research states such categories for the intrahospital and post-discharge models, 16 but not to the postadmission 6-month mortality prediction score. Therefore, cutoff values used in this study for the GRACE-6 score were not based on published scientific data.…”

Section: Limitations Of This Studymentioning

confidence: 99%

ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

Barra¹,

Providência²,

Paiva³

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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“…Four cohorts from the United States, Sweden, and New Zealand showed C‐statistics around 0.61 to 0.69, which are largely comparable to the original C‐statistic in TRA2°P–TIMI50 of 0.67 10. This may reflect the fact that the relative risk for a key risk factor is often generally consistent across different clinical and geographic settings,25, 26 since discrimination reflects the strength of relative risk relationship. Therefore, TRS2°P seems particularly useful in stratifying patients into risk categories (as shown in Figure 3) rather than predicting the absolute risk of having an adverse outcome.…”

Section: Discussionmentioning

confidence: 59%

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

Mok

Ballew

Bash

et al. 2018

JAHA

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BackgroundThe Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0‐to‐9‐point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting.Methods and ResultsWe evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow‐up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person‐years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C‐statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C‐statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta‐analyzed adjusted hazard ratio 1.6–1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3–1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1).ConclusionsTRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings.

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“…В исследовании ACUITY шкала GRACE в подгруппе ЧКВ имела неудовлетворитель-ные показатели С-статистики (0,51) для прогнозиро-вания смертности и важных ишемических событий, тогда как в общей выборке данный показатель был значительно лучше [9]. В других работах модель GRACE также показала недостаточную предсказа-тельную способность у пациентов с ОКС, подверг-шихся ЧКВ [10,11].…”

Section: заключениеunclassified

Implementation of the Grace Score in Acute Coronary Syndrome With Renal Dysfunction

Зыков¹,

Кашталап²,

Быкова³

et al. 2017

Russ J Cardiol

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Цель. Выявить наиболее значимые факторы кардиоваскулярного риска у больных с острым коронарным синдромом (ОкС) и почечной дисфункцией (Пд), перенесших чрескожное коронарное вмешательство (ЧкВ). Материал и методы. В исследование включено 206 пациентов. критерием Пд явилось снижение скорости клубочковой фильтрации (СкФ) <60 мл/ мин/1,73 м 2 , рассчитанного по формуле CKd-ePI (2011) на основании концен-трации креатинина крови при поступлении стационар. Госпитальная леталь-ность составила 13,1% (n=27). Годовая летальность от любых причин соста-вила 15,5% (n=32), 3-х летняя -21,8% (n=45). Результаты. Однофакторный анализ установил, что наиболее значимыми факторами госпитальной и отдаленной летальности у больных с ОкС и Пд, перенесших ЧкВ, явились застойная сердечная недостаточность, инсульт и инфаркт миокарда в анамнезе, острая сердечная недостаточность (ОСН), гипергликемия, выраженная систолическая дисфункция миокарда, тахикардия и гипотония при поступлении в стационар, многососудистое поражение коронарных артерий, а также острое повреждение почек (ОПП), развившееся в течение госпитализации (критерии критериям rIFLe и AKIN). Пошаговый отбор в регрессии кокса показал, что факторами, наличие которых связано с повышением частоты госпитальной летальности, явились инсульт в анамнезе, ОСН на момент поступления, а также развитие ОПП в течение госпитализации. С-статистика полученной модели составила 0,82, что значи-тельно больше, чем у шкалы grACe 2,0-0,74. При проведении анализа долгосрочной выживаемости кокса выявлено, что наличие в анамнезе инсульта и инфаркта миокарда, а также ОСН при посту-плении в стационар и ОПП независимо от других факторов связаны с повыше-нием частоты смертельных исходов в течение одного и трех лет наблюдения. При этом площадь под roC-кривыми собственных моделей риска составила 0,84 и 0,76, соответственно, для года и трех лет. У шкалы grACe 2,0 данный показатель достоверно ниже -0,78 и 0,69, соответственно. Заключение. Приведенные результаты свидетельствуют о том, что у больных ОкС и исходной Пд необходимо учитывать дополнительные факторы при стратификации риска после ЧкВ, а разработанные новые модели оказались достоверно лучше шкалы grACe. Зыков М. В.* -к. м.н., н. с. лаборатории патофизиологии мультифокального атеросклероза, кашталап В. В. -д. м.н., зав. лабораторией патофизиологии мультифокального атеросклероза, доцент кафедры кардиологии и сердечно-сосудистой хирургии, Быкова И. С. -к. м.н., н. с. лаборатории патофизиологии мультифокального атеросклероза, Груздева О. В. -д. м.н., зав. клинико-диа-гностической лабораторией, лабораторией исследования гемостаза, карет-никова В. Н. -д. м.н., зав. лабораторией патологии кровообращения, профес-сор кафедры кардиологии и сердечно-сосудистой хирургии, Барбараш О. Л. -д. м.н., профессор, директор. IMPLEMENTATION OF THE GRACE SCORE IN ACUTE CORONARY SYNDROME WITH RENAL DYSFUNCTIONZykov M. V. Aim. to investigate on the most significant predictors of cardiovascular risk in acute coronary (ACS) and kidney dysfunction (Kd) patients, underwent percutaneous c...

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“Do GRACE (Global Registry of Acute Coronary events) risk scores still maintain their performance for predicting mortality in the era of contemporary management of acute coronary syndromes?”

Cited by 67 publications

References 25 publications

ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

ACHTUNG-Rule: a new and improved model for prognostic assessment in myocardial infarction

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

Implementation of the Grace Score in Acute Coronary Syndrome With Renal Dysfunction

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