External validation of the GRACE risk score and the risk–treatment paradox in patients with acute coronary syndrome

Sangen, Niels M R van der; Azzahhafi, Jaouad; Yin, Dean R P P Chan Pin; Peper, Joyce; Rayhi, Senna; Walhout, Ronald J; Nicastia, D.; Langerveld, Jorina; Vlachojannis, Georgios J.; Bommel, Rutger J. van; Appelman, Yolande; Henriques, José P.S.; Berg, Jurriën Ten; Kikkert, Wouter J.

doi:10.1136/openhrt-2022-001984

Cited by 13 publications

(13 citation statements)

References 31 publications

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“…In general, validation studies of the GRACE score also provided good predictive accuracies, even amongst indigenous populations, with some exceptions ( 43 – 45 ). Despite having good discriminative power and thus identifying higher-risk patients, there has been evidence of both overestimation and underestimation of outcomes risks of the GRACE risk score in different populations ( 46 – 50 ). Compared to the TIMI score, evidence shows that the GRACE risk score was more accurate in predicting long-term mortality ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction

Ismail

Khalil

Mohamad

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe cultural and genetic diversity of the Southeast Asian population has contributed to distinct cardiovascular disease risks, incidence, and prognosis compared to the Western population, thereby raising concerns about the accuracy of predicted risks of existing prognostic models.ObjectivesWe aimed to evaluate the predictive performances of validated, recalibrated, and developed prognostic risk prediction tools used in the Southeast Asian population with acute myocardial infarction (AMI) events for secondary eventsMethodsWe searched MEDLINE and Cochrane Central databases until March 2022. We included prospective and retrospective cohort studies that exclusively evaluated populations in the Southeast Asian region with a confirmed diagnosis of an AMI event and evaluated for risk of secondary events such as mortality, recurrent AMI, and heart failure admission. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review.ResultsWe included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. Both short- and long-term outcomes were assessed. Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. The pooled estimate of the C-statistic in the Southeast Asian population for GRACE risk score is 0.83 (95%CI 0.72–0.90, n = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772–0.83, n = 5 validations). Recalibrated and new models demonstrated marginal improvements in discriminative values. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies.ConclusionBoth TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, with the limited strength of evidence, these results should be interpreted with caution. Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction

Ismail

Khalil

Mohamad

et al. 2022

Front. Cardiovasc. Med.

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“…The TIMI and GRACE scores are two other, in this context, meaningful scores that had the same aim as the SweDen score. The C-statistic from the GRACE score for 1-year mortality was 0.82 (95% CI 0.79-0.84) 10 and TIMI score was 0.65 (95% CI 0.63-0.66) 3 making the SweDen risk score a viable alternative for patients themselves to use. The chosen factors in these different scores are debatable.…”

Section: Discussionmentioning

confidence: 99%

The SweDen risk score- predicting death 1-year after myocardial infarction

Rylance

Wagner

Olesen

et al. 2022

Preprint

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Objectives Our aim was to derive, based on the SWEDEHEART registry, and validate, using the Western Denmark Heart registry, a patient-oriented risk score, the SweDen score, which could calculate the risk of 1-year mortality following a myocardial infarction (MI). Methods The factors included in the SweDen score were age, sex, smoking, diabetes, heart failure, and statin use. These were chosen a priori by the SWEDEHEART steering group based on the premise that the factors were information known by the patients themselves. The score was evaluated using various statistical methods such as time-dependent receiver operating characteristics curves of the linear predictor, area under the curve metrics, Kaplan-Meier survivor curves, and the calibration slope. Results The area under the curve values were 0.81 in the derivation data and 0.76 in the validation data. The Kaplan-Meier curves showed similar patient profiles across datasets. The calibration slope was 1.03 (95% CI 0.99- 1.08) in the validation data using the linear predictor from the derivation data. Conclusions The SweDen risk score is a novel tool created for patient use. The risk score calculator will be available online and presents mortality risk on a colour scale to simplify interpretation and to avoid exact life span expectancies. It provides a validated patient-oriented risk score predicting the risk of death at 1 year after suffering a MI, which visualizes the benefit of statin use and smoking cessation in a simple way.

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“…The TIMI and GRACE scores are two other, in this context, meaningful scores that had the same aim as the SweDen score. The C-statistic from the GRACE score for Coronary artery disease 1-year mortality was 0.82 (95% CI 0.79 to 0.84) 10 and TIMI score was 0.65 (95% CI 0.63 to 0.66), 3 making the SweDen risk score a viable alternative for patients themselves to use. The chosen factors in these different scores are debatable.…”

Section: Discussionmentioning

confidence: 99%

Patient-oriented risk score for predicting death 1 year after myocardial infarction: the SweDen risk score

et al. 2022

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ObjectivesOur aim was to derive, based on the SWEDEHEART registry, and validate, using the Western Denmark Heart registry, a patient-oriented risk score, the SweDen score, which could calculate the risk of 1-year mortality following a myocardial infarction (MI).MethodsThe factors included in the SweDen score were age, sex, smoking, diabetes, heart failure and statin use. These were chosen a priori by the SWEDEHEART steering group based on the premise that the factors were information known by the patients themselves. The score was evaluated using various statistical methods such as time-dependent receiver operating characteristics curves of the linear predictor, area under the curve metrics, Kaplan-Meier survivor curves and the calibration slope.ResultsThe area under the curve values were 0.81 in the derivation data and 0.76 in the validation data. The Kaplan-Meier curves showed similar patient profiles across datasets. The calibration slope was 1.03 (95% CI 0.99 to 1.08) in the validation data using the linear predictor from the derivation data.ConclusionsThe SweDen risk score is a novel tool created for patient use. The risk score calculator will be available online and presents mortality risk on a colour scale to simplify interpretation and to avoid exact life span expectancies. It provides a validated patient-oriented risk score predicting the risk of death within 1 year after suffering an MI, which visualises the benefit of statin use and smoking cessation in a simple way.

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External validation of the GRACE risk score and the risk–treatment paradox in patients with acute coronary syndrome

Cited by 13 publications

References 31 publications

Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction

Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction

The SweDen risk score- predicting death 1-year after myocardial infarction

Patient-oriented risk score for predicting death 1 year after myocardial infarction: the SweDen risk score

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