The following is a summary of “Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes,” published in the August 2023 issue of Cardiology by Georgiopoulos et al.
For a study, researchers aimed to enhance heart attack risk assessment by incorporating high-sensitivity cardiac troponin T into a modified GRACE score. They analyzed data from three cohorts totaling 9,803 ACS patients from September 2009 to December 2017, seeking to improve predictive accuracy. The cohorts included patients from Heidelberg, Newcastle, and the SPUM-ACS study, focusing on the extent of myocardial injury.
Among 9,450 patients studied, 77.4% were male, with an average age of 64.2 years. Researchers utilized continuous rather than binary measurements of hs-cTn T, which improved discrimination and reclassification compared to the original GRACE score in the derivation cohort. For in-hospital mortality, the continuous measure showed an AUC of 0.835 compared to 0.741 for the binary measure, indicating enhanced predictive accuracy. Similarly, for 30-day mortality, the AUC improved from 0.740 to 0.828, signifying better predictive capability.
The modified GRACE risk score showed better performance for in-hospital, 30-day, and 1-year mortality prediction compared to the original GRACE score in both derivation and validation cohorts, demonstrating enhanced discrimination and reclassification. In-hospital mortality, the modified score had an AUC of 0.878 versus 0.780 for the original score and a net reclassification improvement of 0.097.
Researchers concluded that substituting continuous for binary measurements of hs-cTn T in the GRACE risk score improved mortality risk prediction in ACS patients by assessing the extent of myocardial injury.
Source: jamanetwork.com/journals/jamacardiology/fullarticle/2809088