TITLE

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

AUTHOR(S)
Meune, Christophe; Drexler, Beatrice; Haaf, Philip; Reichlin, Tobias; Reiter, Miriam; Meissner, Julia; Twerenbold, Raphael; Stelzig, Claudia; Freese, Michael; Winkler, Katrin; Mueller, Christian
PUB. DATE
September 2011
SOURCE
Heart;Sep2011, Vol. 97 Issue 18, p1479
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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 highsensitivity 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 (174e222) vs 125 (98e155); p<0.001), and in those who died than in those who survived for 1 year (151 (133e169) vs 104 (85e125); 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 (p¼NS 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 (p¼0.058). 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.
ACCESSION #
65162271

 

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