title: Addition of B-type natriuretic peptide to the GRACE score to predict outcome in acute coronary syndrome: a retrospective (development) and prospective (validation) cohort-based study.
abstract: OBJECTIVE
  The present study was designed to build and validate a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) concentrations to predict outcome in patients with acute coronary syndromes (ACS).
  
  
  METHODS
  The GRACE risk score and BNP concentrations were obtained in a retrospective and a prospective cohort. A composite score including the GRACE score and BNP concentrations was first developed in a retrospective cohort of 248 patients with ACS and then validated in a prospective cohort of 575 patients. The primary outcome was 6-month death or myocardial infarction.
  
  
  RESULTS
  End points were reached in 34 patients in the retrospective cohort and in 68 patients in the prospective cohort. Both higher BNP concentration and GRACE score were independently associated with outcome in the retrospective cohort (p=0.003 and p<0.0001). The composite score could be obtained as follows: GRACE+BNP/60. The use of the composite score increased the accuracy of the GRACE score, with an increase in the C statistic from 0.810 (0.727 to 0.892) to 0.822 (0.745 to 0.902) in the retrospective cohort and from 0.724 (0.657 to 0.791) to 0.750 (0.686 to 0.813) in the prospective cohort. Finally, 7% of patients in the prospective study population were reclassified from low to high risk or from high to low risk using this composite score.
  
  
  CONCLUSIONS
  Plasma BNP levels refine the accuracy of the GRACE score. A comprehensive risk score, which includes BNP concentration and the GRACE risk score, might improve ACS risk stratification in clinical practice.
authors.affiliation: Centre Hospitalier Régional et Universitaire de Lille, Cardiology Emergency and Intensive Care Unit, Cardiology Hospital, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Guidez
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Hélène
authors.initials: H
authors.lastname: Lamour
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Barrailler
authors.forename: Vincent
authors.initials: V
authors.lastname: Decourcelle
authors.forename: Sophie
authors.initials: S
authors.lastname: Braun
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouabdallaoui
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Bauchart
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Auffray
authors.forename: Bernadette
authors.initials: B
authors.lastname: Hennache
authors.forename: Francis
authors.initials: F
authors.lastname: Juthier
authors.forename: André
authors.initials: A
authors.lastname: Vincentelli
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D018572:Disease-Free Survival; D006801:Humans; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain