Prognostic Accuracy of the GRACE Score in Octogenarians and Nonagenarians with Acute Coronary Syndromes

Abstract

BackgroundThe GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented.ObjectiveTo test the accuracy of the GRACE score in predicting in-hospital mortality of very elderly individuals with acute coronary syndromes (ACS).MethodsProspective observational study conducted in the intensive coronary care unit of a tertiary center from September 2011 to August 2016. Patients consecutively admitted due to ACS were selected, and the very elderly group was defined by age ≥ 80 years. The GRACE Score was based on admission data and its accuracy was tested regarding prediction of in-hospital death. Statistical significance was defined by p value < 0,05.ResultsA total of 994 individuals was studied, 57% male, 77% with non-ST elevation myocardial infarction and 173 (17%) very elderly patients. The mean age of the sample was 65 ± 13 years, and the mean age of very elderly patients subgroup was 85 ± 3.7 years. The C-statistics of the GRACE Score in very elderly patients was 0.86 (95% CI = 0.78 - 0.93), with no difference when compared to the value for younger individuals 0.83 (95% CI = 0.75 - 0.91), with p = 0.69. The calibration of the score in very elderly patients was described by χ2 test of Hosmer-Lemeshow = 2.2 (p = 0.98), while the remaining patients presented χ2 = 9.0 (p = 0.35). Logistic regression analysis for death prediction did not show interaction between GRACE Score and variable of very elderly patients (p = 0.25).ConclusionThe GRACE Score in very elderly patients is accurate in predicting in-hospital ACS mortality, similarly to younger patients.

Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients

“…Our study shows that a higher GRACE score, more depressed CMR-LVEF and more extensive MVO were independent predictors of MACE in STEMI patients older than 70 years, in line with results in previously published literature. The GRACE score is an excellent predictor of inhospital and 6-month mortality in patients with acute coronary syndrome and has also shown satisfactory accuracy for event prediction in older patients [30,31]. Furthermore, in older patients LVEF is strongly associated with outcomes, and the presence of depressed LVEF has been shown to double the risk of MACE [32].…”

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

“…Contrary to our findings, previous studies have shown that the GRACE risk score retains good discriminative power in older patients, even for 1-year mortality. 24 In our study, the GRACE risk score had moderate discriminative power for predicting 1-year mortality in older patients. Previous work has suggested that adding frailty to the GRACE risk score enhances discrimination for predicting 1-year mortality in patients ≥65 years, but the practicalities of incorporating a frailty assessment should be considered.…”

Myocardial infarction during giant cell arteritis: A cohort study

“…The GRACE score, which assesses the risk of in-hospital mortality, was calculated at admission [39,40]. Data on coronary angiography, reperfusion procedures and medical treatment were also collected.…”