title: External validation of the ProACS score for risk stratification of patients with acute coronary syndromes.
abstract: BACKGROUND
  The ProACS risk score is an early and simple risk stratification score developed for all-cause in-hospital mortality in acute coronary syndromes (ACS) from a Portuguese nationwide ACS registry. Our center only recently participated in the registry and was not included in the cohort used for developing the score. Our objective was to perform an external validation of this risk score for short- and long-term follow-up.
  
  
  METHODS
  Consecutive patients admitted to our center with ACS were included. Demographic and admission characteristics, as well as treatment and outcome data were collected. The ProACS risk score variables are age (≥72 years), systolic blood pressure (≤116 mmHg), Killip class (2/3 or 4) and ST-segment elevation. We calculated ProACS, Global Registry of Acute Coronary Events (GRACE) and Canada Acute Coronary Syndrome risk score (C-ACS) risk scores for each patient.
  
  
  RESULTS
  A total of 3170 patients were included, with a mean age of 64±13 years, 62% with ST-segment elevation myocardial infarction. All-cause in-hospital mortality was 5.7% and 10.3% at one-year follow-up. The ProACS risk score showed good discriminative ability for all considered outcomes (area under the receiver operating characteristic curve >0.75) and a good fit, similar to C-ACS, but lower than the GRACE risk score and slightly lower than in the original development cohort. The ProACS risk score provided good differentiation between patients at low, intermediate and high mortality risk in both short- and long-term follow-up (p<0.001 for all comparisons).
  
  
  CONCLUSIONS
  The ProACS score is valid in external cohorts for risk stratification for ACS. It can be applied very early, at the first medical contact, but should subsequently be complemented by the GRACE risk score.
authors.affiliation: Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. Electronic address: ana_timoteo@yahoo.com.
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Timóteo
authors.affiliation: Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Aguiar Rosa
authors.affiliation: Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Marta Afonso
authors.initials: MA
authors.lastname: Nogueira
authors.affiliation: Centro Nacional de Coleção de Dados em Cardiologia (CNCDC), Sociedade Portuguesa de Cardiologia, Coimbra, Portugal.
authors.forename: Adriana
authors.initials: A
authors.lastname: Belo
authors.affiliation: Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Cruz Ferreira
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors
keywords: Acute coronary syndrome; Estratificação de risco; Portuguese Registry on Acute Coronary Syndromes; Prognosis; Prognóstico; Risk stratification; Síndrome coronária aguda