title: Performance of the GRACE scores in a New Zealand acute coronary syndrome cohort.
abstract: BACKGROUND
  Risk stratification after acute coronary syndrome (ACS) event is recommended to guide intensity and timing of investigation and management. The Global Registry of Acute Coronary Events (GRACE) investigators have published several scores for predicting patient risk both at hospital admission and discharge.
  
  
  OBJECTIVE
  To evaluate the performance of the admission-to-6-month and discharge-to-6-month GRACE scores for predicting myocardial infarction (MI) and mortality in a contemporary cohort of patients admitted with ACS.
  
  
  METHODS
  The cohort comprised 3743 consecutive patients admitted to cardiology services in two large New Zealand hospitals with an ACS between 2007 and 2011. Risk score data was collected in an electronic registry and linked anonymously to national hospitalisation and mortality records.
  
  
  RESULTS
  Between admission and 6 months, 160 patients died and another 269 were rehospitalised with an MI. The GRACE admission-to-6-month total mortality and mortality/MI scores both overestimated event rates approximately twofold. The discharge-to-6-month mortality equation was better calibrated. Global discrimination was very good for both admission-to-6-month and discharge-to-6-month mortality scores (c=0.805 and c=0.795, respectively) and moderately good for the corresponding mortality/MI equations (c=0.652 and c=0.624, respectively).
  
  
  CONCLUSIONS
  In a contemporary ACS cohort, the GRACE discharge-to-6-month mortality score has very good discrimination and accurately predicts mortality rates, whereas the admission-to-6-month equation, despite good discrimination, overestimated risk. Recalibration or more dynamic modelling of in-hospital risk which includes variables such as time from admission to risk assessment are needed to support use of ACS risk assessment in-hospital.
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Gerry
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment