CARDIOVASCULAR MEDICINE

Validity of the GRACE (Global Registry of Acute Coronary Events) acute coronary syndrome prediction model for six month post-discharge death in an independent data set

P J Bradshaw, D T Ko^*, A M Newman, L R Donovan, J V Tu^,

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Correspondence to:
Dr Pamela Bradshaw
School of Population Health, University of Western Australia, M431 Clifton Street Campus, Nedlands, WA 6009, Australia; pamela{at}sph.uwa.edu.au

Objective: To determine the validity of the GRACE (Global Registry of Acute Coronary Events) prediction model for death six months after discharge in all forms of acute coronary syndrome in an independent dataset of a community based cohort of patients with acute myocardial infarction (AMI).

Design: Independent validation study based on clinical data collected retrospectively for a clinical trial in a community based population and record linkage to administrative databases.

Setting: Study conducted among patients from the EFFECT (enhanced feedback for effective cardiac treatment) study from Ontario, Canada.

Patients: Randomly selected men and women hospitalised for AMI between 1999 and 2001.

Main outcome measure: Discriminatory capacity and calibration of the GRACE prediction model for death within six months of hospital discharge in the contemporaneous EFFECT AMI study population.

Results: Post-discharge crude mortality at six months for the EFFECT study patients with AMI was 7.0%. The discriminatory capacity of the GRACE model was good overall (C statistic 0.80) and for patients with ST segment elevation AMI (STEMI) (0.81) and non-STEMI (0.78). Observed and predicted deaths corresponded well in each stratum of risk at six months, although the risk was underestimated by up to 30% in the higher range of scores among patients with non-STEMI.

Conclusions: In an independent validation the GRACE risk model had good discriminatory capacity for predicting post-discharge death at six months and was generally well calibrated, suggesting that it is suitable for clinical use in general populations.

Abbreviations: ACS, acute coronary syndrome; AMI, acute myocardial infarction; EFFECT, enhanced feedback for effective cardiac treatment; GRACE, Global Registry of Acute Coronary Events; PCI, percutaneous catheter based intervention; STEMI, ST segment elevation acute myocardial infarction

Keywords: acute coronary syndrome; risk model; acute myocardial infarction; mortality; population study

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