Abstract 12616: Walking Beyond the Grace Model in the Risk Stratification of Patients With Acute Coronary Syndrome: What Does the Arg, Ncdr and the Euroheart Scores Provide?
INTRODUCTION. Risk stratification plays a pivotal role in the optimal management of acute coronary syndrome (ACS). The most validated risk score (RS) is the GRACE RS, described in 2003. In 2009 an update version of GRACE RS was defined and in 2011 a new RS derived from the ACTION Registry was performed in predicting in-hospital mortality in patients with ACS. For patients undergoing percutaneous coronary intervention (PCI) 2 contemporary models for predicting death risk were described in 2010 and 2011, respectively: The National Cardiovascular Data Registry (NCDR) CathPCI RS and the EuroHeart Score (EHS). We aimed to compare the in-hospital prognostic accuracy of the original GRACE RS, update GRACE RS and AR-G RS, and in the subgroup of patients undergoing PCI the ability of the NCDR and EHS RS in comparison with GRACE RS.
METHODS. 4497 patients ((8.1 ±13.0, 28% female) admitted consecutively between 2004 and 2010 with diagnosis of ACS (32.1% STEMI, 19.2% unstable angina). For each score, in relation to hospital mortality, we calculated the C statistic, a measure of the discriminative ability, and the Hosmer-Lemeshow (HL) test as a measure of power calibration.
RESULTS. Two hundred and sixty-eight (5.9%) patients died in-hospital. Neither updated version of GRACE RS nor AR-G RS managed to improve the predictive accuracy of in-hospital mortality of original version of GRACE RS, for the total population and for subgroups of STEMI and NSTEMI patients (Table 1). For patients underwent PCI since April 2007, EHS and NCDR RS showed a good discrimination (c-value=0.855 [0.799-0.910] and 0.894 [0.843-0.946], respectively), and good calibration (HL P value 0.710 and 0.327, respectively), but not higher than GRACE RS (c-value: 0.910 [0.851-0.961], HL 0.514).
CONCLUSION. Original version of GRACE RS remains the reference in the evaluation of patients with ACS, despite having already spent more than 7 years since its description.
- © 2011 by American Heart Association, Inc.