Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome.
BACKGROUND
The Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score (GRACE score) developed from a multinational registry involving all subsets of acute coronary syndrome (ACS) predicted 6-month survival. There is currently no validated risk model to predict mortality beyond 6 months.


RESULTS
Of the 1143 consecutive patients with ACS admitted to coronary care unit in 2000 to 2002 (mean age, 64.9 +/- 12.6 years), 39% had ST-elevation myocardial infarction, 39% had non-ST-elevation infarction, and 22% had unstable angina. The mortality was 7.5% during index admission, 12.1% at 6 months, 14.8% at 1 year, 18.7% at 2 years, 25.0% at 3 years, and 39.2% at 4 years. The GRACE hospital discharge risk score calculated for 1057 hospital survivors discriminated survival from death at 6 months (C index, 0.81), 1 year (C index, 0.82), 2 years (C index, 0.81), 3 years (C index, 0.81), and 4 years (C index, 0.80). The risk score worked for all 3 subsets of ACS at all time points, with C index >0.75 in all analyses. A separate multivariable mortality model for these 1057 patients over the 4-years follow-up period identified 10 independent predictors of mortality. Seven were in the GRACE risk model (age, history of ischemic heart disease, heart failure, increased heart rate on admission, serum creatinine level, evidence of myonecrosis, not receiving in-hospital percutaneous coronary intervention).


CONCLUSIONS
The GRACE postdischarge risk score contains relevant prognostic factors and accurately discriminate survivors from nonsurvivors over the longer term (up to 4 years) in all subsets of ACS patients.
Tang
Eng Wei
EW
Cardiology Division, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Wong
Cheuk-Kit
CK
Herbison
Peter
P
D000368:Aged; D000789:Angina, Unstable / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D010351:Patient Discharge; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013577:Syndrome
D003404:Creatinine