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The GRACE score's performance in predicting in-hospital and 1-year outcome
  1. Huon H Gray1,
  2. Robert A Henderson2
  1. 1Department of Cardiology, Southampton University Hospital, Southampton, UK
  2. 2Department of Cardiology, Nottingham University Hospitals, Nottingham, UK
  1. Correspondence to Professor H H Gray, Wessex Cardiothoracic and Vascular Unit, Southampton University Hospital, Southampton SO16 6YD, UK; huon{at}cardiology.co.uk

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Acute coronary syndromes (ACS) (unstable angina, non-ST elevation (NSTEMI) and ST-elevation myocardial infarction (STEMI)) are associated with a significant risk of adverse events, including recurrent myocardial ischaemia and infarction, bleeding complications and mortality. In the most recent report of the Myocardial Ischaemia National Audit Project 30-day mortality was still 8.2% for STEMI and 7.1% for NSTEMI, despite a progressive decline over many years.1 Patient outcomes may be improved by pharmacological intervention2 3 and early coronary revascularisation4 5 but analyses from randomised trials suggest that these benefits are restricted to patients with higher levels of cardiovascular risk. Hence an assessment of individual patient risk may be important in selecting management strategies and is recommended as part of the initial assessment of patients presenting with ACS.6–9

Single markers of risk, such as blood levels of cardiac troponin, are not sufficiently accurate predictors of outcome to be clinically useful.10 Various risk models that incorporate multiple determinants of risk have therefore been derived from randomised clinical trials or from registry data and are more accurate than clinical assessment alone.11 Risk models derived from randomised trials, such as the TIMI score,12 have the advantage of being developed from robust scientific data, but are based on selected patient cohorts and their validity in the wider population of patients with ACS is uncertain. By contrast, models derived from registries, such as GRACE (Global Registry of Acute Coronary Events),13–15 are based on analyses of observational data from large unselected populations, often enrolled across many different countries. The GRACE score is a numerical summation of scores attributed to a number of clinical factors …

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