title: Performance of the GRACE Risk Score 2.0 Simplified Algorithm for Predicting 1-Year Death After Hospitalization for an Acute Coronary Syndrome in a Contemporary Multiracial Cohort.
abstract: The GRACE Risk Score is a well-validated tool for estimating short- and long-term risk in acute coronary syndrome (ACS). GRACE Risk Score 2.0 substitutes several variables that may be unavailable to clinicians and, thus, limit use of the GRACE Risk Score. GRACE Risk Score 2.0 performed well in the original GRACE cohort. We sought to validate its performance in a contemporary multiracial ACS cohort, in particular in black patients with ACS. We evaluated the performance of the GRACE Risk Score 2.0 simplified algorithm for predicting 1-year mortality in 2,131 participants in Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE), a multiracial cohort of patients discharged alive after an ACS in 2011 to 2013 from 6 hospitals in Massachusetts and Georgia. The median age of study participants was 61 years, 67% were men, and 16% were black. Half (51%) of the patients experienced a non-ST-segment elevation myocardial infarction (NSTEMI) and 18% STEMI. Eighty patients (3.8%) died within 12 months of discharge. The GRACE Risk Score 2.0 simplified algorithm demonstrated excellent model discrimination for predicting 1-year mortality after hospital discharge in the TRACE-CORE cohort (c-index = 0.77). The c-index was 0.94 in patients with STEMI, 0.78 in those with NSTEMI, and 0.87 in black patients with ACS. In conclusion, the GRACE Risk Score 2.0 simplified algorithm for predicting 1-year mortality exhibited excellent model discrimination across the spectrum of ACS types and racial/ethnic subgroups and, thus, may be a helpful tool to guide routine clinical care for patients with ACS.
authors: Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: wei.huang@umassmed.edu.
authors: Wei
authors: W
authors: Huang
authors: Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Gordon
authors: G
authors: FitzGerald
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Robert J
authors: RJ
authors: Goldberg
authors: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Joel
authors: J
authors: Gore
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Richard H
authors: RH
authors: McManus
authors: Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia.
authors: Hamza
authors: H
authors: Awad
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Molly E
authors: ME
authors: Waring
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Jeroan
authors: J
authors: Allison
authors: Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts.
authors: Jane S
authors: JS
authors: Saczynski
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Catarina I
authors: CI
authors: Kiefe
authors: Center for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors: Keith A A
authors: KA
authors: Fox
authors: Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Frederick A
authors: FA
authors: Anderson
authors: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: David D
authors: DD
authors: McManus
mesh_terms: D054058:Acute Coronary Syndrome; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005845:Georgia; D006323:Heart Arrest / Q000453:epidemiology; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009026:Mortality; D000072658:Non-ST Elevated Myocardial Infarction; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D004232:Diuretics; D003404:Creatinine