Abstract
Background
Global Registry of Acute Coronary Events (GRACE) score has been routinely used for
risk stratification in acute coronary syndromes (ACS). We aimed to investigate whether
the GRACE score has remained relevant with contemporary treatment of patients with
ACS.
Methods
Included were patients with ACS in the Acute Coronary Syndrome Israeli Survey (ACSIS).
Patients were divided into high (> 140) and low–intermediate (≤ 140) GRACE score.
Outcomes were compared for each GRACE score group among patients enrolled in early
(2000 to 2006), mid (2008 to 2010) and late (2013 to 2016) surveys.
Results
Included were 4931 patients. For patients with GRACE scores > 140, temporal improvements
in therapy were associated with reduced 7-day all-cause mortality (5.7%, 4.1%, and
2.0% for patients in early, mid-, and late surveys, respectively, P = 0.01) and 1-year mortality rates (27.8%, 25.3%, and 21.8% for patients in early,
mid-, and late surveys, respectively, P = 0.07). Among patients with GRACE scores ≤ 140, all-cause mortality rates at 1 year
were lower among participants enrolled in recent surveys (5.3%, 3.5%, and 3.1% for
patients in early, mid-, and late surveys, respectively, P = 0.01). No significant differences in the accuracy of the GRACE score in predicting
7-day mortality were observed, (area under the curve [AUC] = 0.83, 0.87, and 0.75
for early, mid-, and late surveys, respectively, P = NS). Similarly, for 1-year all-cause mortality, the accuracy of the GRACE score
remained comparable (AUC = 0.79, 0.84, and 0.82 for early, mid-, and late surveys,
respectively, P = NS).
Conclusions
Our results validated the accuracy of the GRACE score for risk stratification in ACS.
The discrimination of the score has not been influenced by the better outcome with
latest treatment.
Résumé
Contexte
Le score GRACE (Global Registry of Acute Coronary Events) est couramment utilisé pour stratifier le risque dans les cas de syndrome coronarien
aigu (SCA). Notre étude visait à déterminer si le score GRACE conservait sa pertinence
au regard des modalités récentes de traitement des patients atteints d’un SCA.
Méthodologie
L’étude portait sur les patients atteints de SCA qui avaient pris part à l’Acute Coronary
Syndrome Israeli Survey (ACSIS). Les patients ont été divisés en deux groupes selon
que leur score GRACE était élevé (> 140) ou faible à intermédiaire (≤ 140). Dans chaque
groupe de score GRACE, on a comparé les patients qui avaient pris part à l’enquête
pendant la période initiale (de 2000 à 2006), la période intermédiaire (de 2008 à
2010) et la période récente (de 2013 à 2016).
Résultats
L’étude portait sur 4931 patients. Chez ceux dont le score GRACE était > 140, les
améliorations thérapeutiques temporelles ont été associées à une réduction de la mortalité
toutes causes confondues après 7 jours (5,7 %, 4,1 % et 2,0 % pour les participants
des périodes initiale, intermédiaire et récente, respectivement, p = 0,01) et après 1 an (27,8 %, 25,3 % et 21,8 % pour les participants des périodes
initiale, intermédiaire et récente, respectivement, p = 0,07). Chez les patients dont le score GRACE était ≤ 140, les taux de mortalité
toutes causes confondues après 1 an étaient plus faibles chez les participants ayant
participé à l’enquête durant la période récente (5,3 %, 3,5 % et 3,1 % pour les participants
des périodes initiale, intermédiaire et récente, respectivement, p = 0,01). Aucune différence significative quant à l’exactitude du score GRACE pour
prédire la mortalité après 7 jours n’a été observée (aire sous la courbe [ASC] = 0,83,
0,87 et 0,75 pour les périodes initiale, intermédiaire et récente de participation
à l’enquête, respectivement, p = non significatif). De même, pour la mortalité toutes causes confondues après 1
an, l’exactitude prédictive du score GRACE est demeurée similaire (ASC = 0,79, 0,84
et 0,82 pour les périodes initiale, intermédiaire et récente de participation à l’enquête,
respectivement, p = non significatif).
Conclusions
Nos résultats ont permis de valider l’exactitude prédictive du score GRACE pour la
stratification du risque dans le SCA. La discrimination de ce score n’a pas été modifiée
par l’amélioration des résultats obtenue avec les modalités thérapeutiques les plus
récentes.
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Article info
Publication history
Published online: October 12, 2018
Accepted:
September 27,
2018
Received:
July 1,
2018
Footnotes
See page 1617 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
