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Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?
Belén Álvarez-Álvarez1, Sergio Raposeiras-Roubín1, Emad Abu-Assi1
1Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain.
Insights
The GRACE risk score effectively identifies patients at high risk of post-acute coronary syndrome (ACS) ischemic stroke. Both GRACE and CHA2DS2VASc scores showed high negative predictive values, aiding clinical decision-making.
Area of Science:
- Cardiology
- Neurology
- Clinical Risk Prediction
Background:
- The incidence of stroke following acute coronary syndrome (ACS) is a growing concern.
- Accurate risk stratification is crucial for managing patients post-ACS.
Purpose of the Study:
- To comparatively validate the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and the CHA2DS2VASc risk score.
- To assess their efficacy in predicting ischemic stroke risk in patients after ACS.
Main Methods:
- Retrospective study of 4229 patients discharged after ACS (2004-2010).
- Primary endpoint: occurrence of ischemic stroke during a median follow-up of 4.6 years.
- Comparative analysis of GRACE and CHA2DS2VASc scores for predictive accuracy.
Main Results:
- 184 (4.4%) patients experienced ischemic stroke; stroke patients were older with more comorbidities.
- Both scores demonstrated adequate discriminative ability (c-indices 0.63 for CHA2DS2VASc, 0.60 for GRACE).
- CHA2DS2VASc had higher sensitivity (95.1%) but lower specificity (14.4%) compared to GRACE (87.0% sensitivity, 30.2% specificity).
- Both scores exhibited high negative predictive values (≥98.1%).
Conclusions:
- The 6-month GRACE risk score is a valuable tool for identifying high-risk patients for ischemic stroke after ACS.
- While both scores are useful, GRACE may offer a more balanced profile for certain clinical scenarios post-ACS.
Objectives:
The risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke.
Methods:
This was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7-7.1 years).
Results:
184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%).
Conclusions:
The 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.
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