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GRACE Score Validation in Predicting Hospital Mortality: Analysis of the Role of Sex

Eva de-Miguel-Balsa1, Jaime Latour-Pérez1, Anna Baeza-Román1

  • 1Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Spain.

Journal of Women'S Health (2002)
|January 21, 2017
PubMed

Insights

The GRACE score for acute coronary syndrome (ACS) risk stratification showed lower accuracy in women with ST-segment elevation myocardial infarction (STEMI). While female sex independently predicted mortality in STEMI, it did not significantly improve the GRACE score

Area of Science:

  • Cardiology and Cardiovascular Diseases
  • Clinical Risk Stratification
  • Health Outcomes Research

Background:

  • The GRACE (Global Registry of Acute Coronary Events) risk score is a standard tool for risk stratification in acute coronary syndrome (ACS).
  • However, the GRACE score does not incorporate sex, despite its known association with ACS prognosis.
  • This study addresses the need to evaluate the prognostic value of sex in contemporary ACS populations.

Purpose of the Study:

  • To determine if incorporating sex into the GRACE risk score enhances prognostic information in a contemporary patient cohort.
  • To assess the performance of the GRACE score in different subpopulations, specifically ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).

Main Methods:

  • Analysis of discrimination and calibration of the GRACE score using data from the ARIAM-SEMICYUC registry (2012-2015).
  • Hospital mortality was the primary outcome measure.
  • The study evaluated the GRACE score's uniformity of fit in STEMI and NSTEMI subpopulations.

Main Results:

  • A total of 9781 patients were analyzed, with 4598 (28% women) having NSTEMI and 5183 (23% women) having STEMI.
  • The GRACE score's discriminative capacity was significantly lower in women with STEMI compared to men (AUC 0.82 vs. 0.90, p=0.0006).
  • Female sex independently predicted hospital mortality in STEMI (p=0.019) but not NSTEMI (p=0.356), with a significant interaction (p=0.0308).
  • Despite independent prediction, including female sex did not substantially improve the GRACE score's discriminative ability in STEMI (NRI 0.0011, p=0.928).

Conclusions:

  • Although female sex is an independent predictor of hospital mortality in STEMI patients, its inclusion does not significantly enhance the GRACE score's discriminative performance.
  • The findings suggest limitations in the GRACE score's ability to fully capture prognostic information in specific subgroups, particularly women with STEMI.
  • Further research may be needed to refine risk stratification tools for ACS, considering sex-specific differences.

Keywords:
GRACE scoreacute coronary syndromefemale sexhospital mortality

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