Tags

Type your tag names separated by a space and hit enter

GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome.
Int J Cardiol. 2017 Oct 01; 244:24-29.IJ

Abstract

BACKGROUND

Although there are sex differences in management and outcome of acute coronary syndromes (ACS), sex is not a component of Global Registry of Acute Coronary Events (GRACE) risk score (RS) for in-hospital mortality prediction. We sought to determine the prognostic utility of GRACE RS in men and women, and whether its predictive accuracy would be augmented through sex-based modification of its components.

METHODS

Canadian men and women enrolled in GRACE and Canadian Registry of Acute Coronary Events were stratified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS). GRACE RS was calculated as per original model. Discrimination and calibration were evaluated using the c-statistic and Hosmer-Lemeshow goodness-of-fit test, respectively. Multivariable logistic regression was undertaken to assess potential interactions of sex with GRACE RS components.

RESULTS

For the overall cohort (n=14,422), unadjusted in-hospital mortality rate was higher in women than men (4.5% vs. 3.0%, p<0.001). Overall, GRACE RS c-statistic and goodness-of-fit test p-value were 0.85 (95% CI 0.83-0.87) and 0.11, respectively. While the RS had excellent discrimination for all subgroups (c-statistics >0.80), discrimination was lower for women compared to men with STEMI [0.80 (0.75-0.84) vs. 0.86 (0.82-0.89), respectively, p<0.05]. The goodness-of-fit test showed good calibration for women (p=0.86), but suboptimal for men (p=0.031). No significant interaction was evident between sex and RS components (all p>0.25).

CONCLUSIONS

The GRACE RS is a valid predictor of in-hospital mortality for both men and women with ACS. The lack of interaction between sex and RS components suggests that sex-based modification is not required.

Authors+Show Affiliations

University of Toronto, Toronto, ON, Canada.University of Toronto, Toronto, ON, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, Canadian Heart Research Centre, Toronto, ON, Canada.Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.Flinders University, South Australia, Australia.Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.McGill University Health Centre, McGill University, Montreal, QC, Canada.Cornwall Community Hospital, Cornwall, ON and University of Ottawa, Ottawa, ON, Canada.The Moncton Hospital, Moncton, NB and Dalhousie University, Halifax, NS, Canada.Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.Cardiovascular Division, Women's College Hospital, Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, ON, Canada.Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.University of Toronto, Toronto, ON, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, Canadian Heart Research Centre, Toronto, ON, Canada. Electronic address: yana@smh.ca.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

28645803

Citation

Gong, Inna Y., et al. "GRACE Risk Score: Sex-based Validity of In-hospital Mortality Prediction in Canadian Patients With Acute Coronary Syndrome." International Journal of Cardiology, vol. 244, 2017, pp. 24-29.
Gong IY, Goodman SG, Brieger D, et al. GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome. Int J Cardiol. 2017;244:24-29.
Gong, I. Y., Goodman, S. G., Brieger, D., Gale, C. P., Chew, D. P., Welsh, R. C., Huynh, T., DeYoung, J. P., Baer, C., Gyenes, G. T., Udell, J. A., Fox, K. A. A., & Yan, A. T. (2017). GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome. International Journal of Cardiology, 244, 24-29. https://doi.org/10.1016/j.ijcard.2017.06.055
Gong IY, et al. GRACE Risk Score: Sex-based Validity of In-hospital Mortality Prediction in Canadian Patients With Acute Coronary Syndrome. Int J Cardiol. 2017 Oct 1;244:24-29. PubMed PMID: 28645803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome. AU - Gong,Inna Y, AU - Goodman,Shaun G, AU - Brieger,David, AU - Gale,Chris P, AU - Chew,Derek P, AU - Welsh,Robert C, AU - Huynh,Thao, AU - DeYoung,J Paul, AU - Baer,Carolyn, AU - Gyenes,Gabor T, AU - Udell,Jacob A, AU - Fox,Keith A A, AU - Yan,Andrew T, AU - ,, Y1 - 2017/06/15/ PY - 2016/12/21/received PY - 2017/04/13/revised PY - 2017/06/13/accepted PY - 2017/6/25/pubmed PY - 2018/5/4/medline PY - 2017/6/25/entrez KW - Acute coronary syndrome KW - GRACE risk score KW - Risk stratification KW - Sex differences KW - Validation SP - 24 EP - 29 JF - International journal of cardiology JO - Int J Cardiol VL - 244 N2 - BACKGROUND: Although there are sex differences in management and outcome of acute coronary syndromes (ACS), sex is not a component of Global Registry of Acute Coronary Events (GRACE) risk score (RS) for in-hospital mortality prediction. We sought to determine the prognostic utility of GRACE RS in men and women, and whether its predictive accuracy would be augmented through sex-based modification of its components. METHODS: Canadian men and women enrolled in GRACE and Canadian Registry of Acute Coronary Events were stratified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS). GRACE RS was calculated as per original model. Discrimination and calibration were evaluated using the c-statistic and Hosmer-Lemeshow goodness-of-fit test, respectively. Multivariable logistic regression was undertaken to assess potential interactions of sex with GRACE RS components. RESULTS: For the overall cohort (n=14,422), unadjusted in-hospital mortality rate was higher in women than men (4.5% vs. 3.0%, p<0.001). Overall, GRACE RS c-statistic and goodness-of-fit test p-value were 0.85 (95% CI 0.83-0.87) and 0.11, respectively. While the RS had excellent discrimination for all subgroups (c-statistics >0.80), discrimination was lower for women compared to men with STEMI [0.80 (0.75-0.84) vs. 0.86 (0.82-0.89), respectively, p<0.05]. The goodness-of-fit test showed good calibration for women (p=0.86), but suboptimal for men (p=0.031). No significant interaction was evident between sex and RS components (all p>0.25). CONCLUSIONS: The GRACE RS is a valid predictor of in-hospital mortality for both men and women with ACS. The lack of interaction between sex and RS components suggests that sex-based modification is not required. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/28645803/GRACE_risk_score:_Sex_based_validity_of_in_hospital_mortality_prediction_in_Canadian_patients_with_acute_coronary_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(16)34711-8 DB - PRIME DP - Unbound Medicine ER -