External validation of the GRACE risk score 2.0 in the contemporary all‐comers GLOBAL LEADERS trial

Abstract

Objectives This study aimed to assess the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in contemporary acute coronary syndrome (ACS) patients, and its relation to antiplatelet strategies. Background The predictive value of the GRACE risk score in the contemporary ACS cohort and the appropriate antiplatelet regimen according to the risk remain unclear. Methods This is a subgroup analysis of the all‐comers, randomized GLOBAL LEADERS trial, comparing ticagrelor monotherapy versus conventional dual‐antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The GRACE risk score 2.0 with 1‐year mortality prediction was implemented. The randomized antiplatelet effect was assessed in predefined three GRACE risk‐groups; low‐risk (GRACE <109), moderate‐risk (GRACE 109–140), and high‐risk (GRACE >140). Results The GRACE risk score was available in 6,594 out of 7,487 ACS patients among whom 1,743, 2,823, and 2,028 patients were classified as low‐risk, moderate‐risk, and high‐risk, respectively. At 1 year, all‐cause mortality occurred in 120 patients (1.8%). The discrimination ability of the GRACE model was moderate (C‐statistic = 0.742), whereas 1‐year mortality risk was overestimated (mean predicted mortality rate: 3.9%; the Hosmer‐Lemeshow chi‐square: 21.47; p = 0.006). There were no significant interactions between the GRACE risk strata and effects of the ticagrelor monotherapy on ischemic or bleeding outcomes at 1 year compared to the reference strategy. Conclusion The GRACE risk score 2.0 is valuable in discriminating high risk ACS patients, however, the recalibration of the score is recommended for better risk stratification. There is no significant differences in efficacy and safety of ticagrelor monotherapy across the three GRACE risk strata.

Living alone predicts poor prognosis among patients with acute myocardial infarction

“…The GRACE risk score is useful for estimating in-hospital mortality at the time of admission [ 2 ]. In the original investigation, only 15% of study patients underwent reperfusion therapy [ 2 ], but this score is valuable for discriminating high-risk AMI patients under contemporary treatments [ 4 , 21 ]. Naturally, GRACE risk score is significantly associated with all-cause and cardiac deaths after PCI in our study, and both GRACE risk score and living alone independently correlated with all-cause and cardiac deaths.…”

“…Acute myocardial infarction (AMI) is an important public health issue and a major cause of death worldwide [ 1 ], and assessment of the mortality risk in AMI patients is crucial when making medical decisions. The Global Registry of Acute Coronary Events (GRACE) risk score is useful for estimating in-hospital mortality at the time of admission [ 2 ] and is in wide use [ 3 , 4 ]. European Society of Cardiology and the Japanese Circulation Society recommend the use of this risk score in estimating AMI patient mortality [ 5 , 6 ].…”