title: Validation of two US risk scores for percutaneous coronary intervention in a single-center Portuguese population of patients with acute coronary syndrome.
abstract: BACKGROUND
  New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score.
  
  
  METHODS
  In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores.
  
  
  RESULTS
  A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91-0.96) compared with NCDR (0.87, 95% CI 0.83-0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81-0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6-97.7; IDI 0.136, 95% CI 0.073-0.199) or NCDR (NRI 79.2, 95% CI 60.2-98.2; IDI 0.148, 95% CI 0.087-0.209).
  
  
  CONCLUSIONS
  The NCDR and Mayo Clinic risk scores are useful for risk stratification of in-hospital mortality in a European population of patients with ACS undergoing coronary angioplasty. However, the GRACE score is still to be preferred.
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. Electronic address: ana_timoteo@yahoo.com.
authors.forename: Ana T
authors.initials: AT
authors.lastname: Timóteo
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: André V
authors.initials: AV
authors.lastname: Monteiro
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Portugal
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Teixeira
authors.affiliation: Minalytics, Advanced Solutions for Data Mining and Analytics, Lisbon, Portugal; Instituto de Telecomunicações, Instituto Superior Técnico, Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Aidos
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: C Ferreira
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012042:Registries; D018570:Risk Assessment
keywords: Acute coronary syndromes; Angioplastia coronária; Coronary angioplasty; Estratificação de risco; Risk stratification; Scores; Síndromes coronárias agudas