title: Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.
abstract: OBJECTIVE
  Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission.
  
  
  METHODS
  This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke.
  
  
  RESULTS
  One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values.
  
  
  CONCLUSIONS
  The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice.
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Spain. Electronic address: raposeiras26@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubín
authors.affiliation: Department of Cardiology, University Clinical Hospital of 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, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Cambeiro-González
authors.affiliation: Department of Cardiology, University Clinical Hospital of 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, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Pereira-López
authors.affiliation: Department of Cardiology, University Clinical Hospital of 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, Spain.
authors.forename: Milagros
authors.initials: M
authors.lastname: Pedreira-López
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Rigueiro-Veloso
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Virgós-Lamela
authors.affiliation: Department of Cardiology, University Clinical Hospital of 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, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
keywords: 30-day events; Acidente vascular cerebral; Eventos aos 30 dias; GRACE risk score; Heart failure; Insuficiência cardíaca; Mortalidade; Mortality; Reenfarte; Reinfarction; Score de risco GRACE; Stroke