The Global Registry of Acute Coronary Events (GRACE) score was created to determine risk in individuals with the acute coronary syndrome who have or lack ST-segment elevation. Little was known regarding the efficacy of race and ethnicity in predicting in-hospital mortality for ethnic minorities. In the Myocardial Infarction National Audit Project (MINAP), 2010–17, there were 326,160 non-ST-segment elevations myocardial infarction (NSTEMI) admissions (White=299,184; ethnic minorities excluded White minorities=26,976), including Whites and ethnic minorities. The researchers defined low, intermediate, and high-risk groups based on the grace score for in-hospital mortality and evaluated ethnic group baseline qualities. The accuracy of the grace risk score was assessed by discrimination (receiver operating characteristic curve) and calibration (calibration plots). Cardiometabolic risk factors, such as diabetes and high cholesterol levels, were more prevalent among ethnic minorities in all GRACE risk groups. The GRACE risk score for White [AUC 0.87, 95% confidence interval (CI) 0.86–0.88] and ethnic minority (AUC 0.87, 95% CI 0.86–0.88) patients showed good discrimination, according to the findings. However, in white patients, the GRACE risk model was well-calibrated (expected to observe (E: O) in-hospital death rate ratio 0.99; slope 1.00), but it underestimated danger in ethnic minority patients (E: O ratio 1.29; slope 0.94). The GRACE risk score was effective overall for in-hospital mortality but not well-calibrated and overstated risk for ethnic minorities with NSTEMI.
Link:academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac052/6529720?searchresult=1
