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The GRACE score's performance in predicting in-hospital and 1-year outcome in the era of high-sensitivity cardiac troponin assays and B-type natriuretic peptide
  1. Christophe Meune1,2,
  2. Beatrice Drexler1,
  3. Philip Haaf1,
  4. Tobias Reichlin1,3,
  5. Miriam Reiter1,
  6. Julia Meissner1,
  7. Raphael Twerenbold1,
  8. Claudia Stelzig1,
  9. Michael Freese1,
  10. Katrin Winkler4,5,
  11. Christian Mueller1,3
  1. 1Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
  2. 2Paris Descartes University, Department of Cardiology, Cochin Hospital, APHP, Paris, France
  3. 3Department of Cardiology, University Hospital Basel, Switzerland
  4. 4Department of Pneumology, Hospital del Mar—IMIM, UPF, CIBERES, ISC III, Barcelona, Spain
  5. 5Emergengy Department, Hospital del Mar–IMIM, Barcelona, Spain
  1. Correspondence to Professor Christian Mueller, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; chmueller{at}


Objective To compare the accuracy of the GRACE score, a strong prognosticator in acute coronary syndrome (ACS) that is calculated using conventional cardiac troponin (cTn) assays, with that calculated with high-sensitivity cTn (hs-cTn) and with the combination of the GRACE score with hs-cTn or B-type natriuretic peptide (BNP).

Design Prospective international cohort.

Settings University Hospital.

Patients Patients enrolled in the Predictors of Acute Coronary Syndromes Evaluation prospective study with proven ACS.

Main outcome measured The capacity to predict in-hospital mortality, 1-year mortality and combined death/acute myocardial infarction (AMI) at 1 year.

Results 370 patients were enrolled (173 with unstable angina and 197 with AMI). In-hospital mortality was 4.1%; 1-year mortality was 12.5%. The GRACE score was significantly higher in patients who died than in those discharged alive (200 (174–222) vs 125 (98–155); p<0.001), and in those who died than in those who survived for 1 year (151 (133–169) vs 104 (85–125); p<0.001). The area under the curve of the GRACE score was 0.87 regarding in-hospital mortality and 0.88 for 1-year mortality; if calculated with hs-cTn, it was 0.87 and 0.88, respectively (p=NS for all comparisons). The addition of hs-cTn to the GRACE score resulted in no increased value, whereas the addition of BNP tended to improve 1-year mortality prediction (p=0.058).

Conclusion The GRACE score is accurate for determining both in-hospital and long-term mortality in patients with ACS in the era of hs-cTn. The addition of hs-cTn or BNP to the GRACE score does not significantly improve risk prediction.

  • Acute coronary syndrome
  • GRACE score
  • high-sensitive
  • cardiac troponins
  • B-type natriuretic peptide
  • risk stratification
  • angina—unstable
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  • See Editorial, p 1461

  • Funding This study was supported by grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Abbott, Roche, Siemens and the Department of Internal Medicine, University Hospital Basel. CM was supported by a grant from the Freie Akademische Gesellschaft Basel (FAG).

  • Competing interests CM received research grant support from Abbott, Brahms, nanosphere, Roche and Siemens, consulting fees from Abbott, and lecture fees from Abbott, Biosite, Brahms, Roche and Siemens.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the University Hospital Basel.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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