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Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada.
Am Heart J. 2009 Sep; 158(3):392-9.AH

Abstract

BACKGROUND

The Global Registry of Acute Coronary Event (GRACE) risk score was developed in a large multinational registry to predict in-hospital mortality across the broad spectrum of acute coronary syndromes (ACS). Because of the substantial regional variation and temporal changes in patient characteristics and management patterns, we sought to validate this risk score in a contemporary Canadian population with ACS.

METHODS

The main GRACE and GRACE(2) registries are prospective, multicenter, observational studies of patients with ACS (June 1999 to December 2007). For each patient, we calculated the GRACE risk score and evaluated its discrimination and calibration by the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. To assess the impact of temporal changes in management on the GRACE risk score performance, we evaluated its discrimination and calibration after stratifying the study population into prespecified subgroups according to enrollment period, type of ACS, and whether the patient underwent coronary angiography or revascularization during index hospitalization.

RESULTS

A total of 12,242 Canadian patients with ACS were included; the median GRACE risk score was 127 (25th and 75th percentiles were 103 and 157, respectively). Overall, the GRACE risk score demonstrated excellent discrimination (c statistic 0.84, 95% CI 0.82-0.86, P < .001) for in-hospital mortality. Similar results were seen in all the subgroups (all c statistics >/=0.8). However, calibration was suboptimal overall (Hosmer-Lemeshow P = .06) and in various subgroups.

CONCLUSIONS

GRACE risk score is a valid and powerful predictor of adverse outcomes across the wide range of Canadian patients with ACS. Its excellent discrimination is maintained despite advances in management over time and is evident in all patient subgroups. However, the predicted probability of in-hospital mortality may require recalibration in the specific health care setting and with advancements in treatment.

Authors+Show Affiliations

Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Validation Study

Language

eng

PubMed ID

19699862

Citation

Elbarouni, Basem, et al. "Validation of the Global Registry of Acute Coronary Event (GRACE) Risk Score for In-hospital Mortality in Patients With Acute Coronary Syndrome in Canada." American Heart Journal, vol. 158, no. 3, 2009, pp. 392-9.
Elbarouni B, Goodman SG, Yan RT, et al. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. Am Heart J. 2009;158(3):392-9.
Elbarouni, B., Goodman, S. G., Yan, R. T., Welsh, R. C., Kornder, J. M., Deyoung, J. P., Wong, G. C., Rose, B., Grondin, F. R., Gallo, R., Tan, M., Casanova, A., Eagle, K. A., & Yan, A. T. (2009). Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. American Heart Journal, 158(3), 392-9. https://doi.org/10.1016/j.ahj.2009.06.010
Elbarouni B, et al. Validation of the Global Registry of Acute Coronary Event (GRACE) Risk Score for In-hospital Mortality in Patients With Acute Coronary Syndrome in Canada. Am Heart J. 2009;158(3):392-9. PubMed PMID: 19699862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. AU - Elbarouni,Basem, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Welsh,Robert C, AU - Kornder,Jan M, AU - Deyoung,J Paul, AU - Wong,Graham C, AU - Rose,Barry, AU - Grondin,François R, AU - Gallo,Richard, AU - Tan,Mary, AU - Casanova,Amparo, AU - Eagle,Kim A, AU - Yan,Andrew T, AU - ,, PY - 2009/03/10/received PY - 2009/06/02/accepted PY - 2009/8/25/entrez PY - 2009/8/25/pubmed PY - 2009/10/9/medline SP - 392 EP - 9 JF - American heart journal JO - Am Heart J VL - 158 IS - 3 N2 - BACKGROUND: The Global Registry of Acute Coronary Event (GRACE) risk score was developed in a large multinational registry to predict in-hospital mortality across the broad spectrum of acute coronary syndromes (ACS). Because of the substantial regional variation and temporal changes in patient characteristics and management patterns, we sought to validate this risk score in a contemporary Canadian population with ACS. METHODS: The main GRACE and GRACE(2) registries are prospective, multicenter, observational studies of patients with ACS (June 1999 to December 2007). For each patient, we calculated the GRACE risk score and evaluated its discrimination and calibration by the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. To assess the impact of temporal changes in management on the GRACE risk score performance, we evaluated its discrimination and calibration after stratifying the study population into prespecified subgroups according to enrollment period, type of ACS, and whether the patient underwent coronary angiography or revascularization during index hospitalization. RESULTS: A total of 12,242 Canadian patients with ACS were included; the median GRACE risk score was 127 (25th and 75th percentiles were 103 and 157, respectively). Overall, the GRACE risk score demonstrated excellent discrimination (c statistic 0.84, 95% CI 0.82-0.86, P < .001) for in-hospital mortality. Similar results were seen in all the subgroups (all c statistics >/=0.8). However, calibration was suboptimal overall (Hosmer-Lemeshow P = .06) and in various subgroups. CONCLUSIONS: GRACE risk score is a valid and powerful predictor of adverse outcomes across the wide range of Canadian patients with ACS. Its excellent discrimination is maintained despite advances in management over time and is evident in all patient subgroups. However, the predicted probability of in-hospital mortality may require recalibration in the specific health care setting and with advancements in treatment. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19699862/Validation_of_the_Global_Registry_of_Acute_Coronary_Event__GRACE__risk_score_for_in_hospital_mortality_in_patients_with_acute_coronary_syndrome_in_Canada_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00452-9 DB - PRIME DP - Unbound Medicine ER -