title: Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?
abstract: The risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke.
  
  
  
  This was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7-7.1 years).
  
  
  
  184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%).
  
  
  
  The 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Álvarez-Álvarez
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubín
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Cambeiro-González
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Gestal-Romaní
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: López-López
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Bouzas-Cruz
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: María
authors.initials: M
authors.lastname: Castiñeira-Busto
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Ozoda
authors.initials: O
authors.lastname: Saidhodjayeva
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Redondo-Diéguez
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Pereira López
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: García-Acuña
authors.affiliation: Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey