title: Recalibration of the Global Registry of Acute Coronary Events risk score in a multiethnic Asian population.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) is a leading cause of mortality in Asia. However, quantitative risk scores to predict mortality after AMI were developed without the participation of Asian countries.
  
  
  METHODS
  We evaluated the performance of the Global Registry of Acute Coronary Events (GRACE) in-hospital mortality risk score, directly and after recalibration, in a large Singaporean cohort representing 3 major Asian ethnicities.
  
  
  RESULTS
  The GRACE cohort included 11,389 patients, predominantly of European descent, hospitalized for AMI or unstable angina from 2002 to 2003. The Singapore cohort included 10,100 Chinese, 3,005 Malay, and 2,046 Indian patients hospitalized for AMI from 2002 to 2005.Using the original GRACE score, predicted in-hospital mortality was 2.4% (Chinese), 2.0% (Malay), and 1.6% (Indian). However, observed in-hospital mortality was much greater at 9.8% (Chinese), 7.6% (Malay), and 6.4% (Indian). The c statistic for Chinese, Malays, and Indians was 0.86, 0.86, and 0.84, respectively, and the Hosmer-Lemeshow statistic was 250, 56, and 41, respectively. Recalibration of the GRACE score, using the mean-centered constants derived from the Singapore cohort, did not change the c statistic but substantially improved the Hosmer-Lemeshow statistic to 90, 24, and 18, respectively. The recalibrated GRACE score predicted in-hospital mortality as follows: 7.7% (Chinese), 6.0% (Malay), and 5.2% (Indian).
  
  
  CONCLUSIONS
  In this large cohort of 3 major Asian ethnicities, the original GRACE score, derived from populations outside Asia, underestimated in-hospital mortality after AMI. Recalibration improved risk estimation substantially and may help adapt externally developed risk scores for local practice.
authors.affiliation: National University Heart Centre, Singapore, Singapore. mark_chan@nuhs.edu.sg
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.forename: Ling Ling
authors.initials: LL
authors.lastname: Sim
authors.forename: Terrance
authors.initials: T
authors.lastname: Chua
authors.forename: Huay Cheem
authors.initials: HC
authors.lastname: Tan
authors.forename: Tiong Cheng
authors.initials: TC
authors.lastname: Yeo
authors.forename: Hean Yee
authors.initials: HY
authors.lastname: Ong
authors.forename: David
authors.initials: D
authors.lastname: Foo
authors.forename: Ping Ping
authors.initials: PP
authors.lastname: Goh
authors.forename: Soondal K
authors.initials: SK
authors.lastname: Surrun
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Tian Hai
authors.initials: TH
authors.lastname: Koh
authors.forename: Agus
authors.initials: A
authors.lastname: Salim
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
mesh_terms: D054058:Acute Coronary Syndrome / Q000208:ethnology*; D000368:Aged; D044466:Asian People; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012846:Singapore / Q000453:epidemiology