Related Experiment Video
Updated: Feb 24, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China
Yong Peng1, Xin Du2, Kris D Rogers3
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China; The George Institute for Global Health, University of Sydney, Sydney, Australia.
Insights
A new risk score (RS) for acute coronary syndrome patients in China was developed. This CPACS RS demonstrated improved accuracy and reduced bias compared to the GRACE RS, offering better risk prediction for Chinese populations.
Area of Science:
- Cardiology
- Public Health
- Clinical Risk Prediction
Background:
- Existing risk scores (RSs) for acute coronary syndrome (ACS) lack representation from Chinese populations.
- The Global Registry of Acute Coronary Events (GRACE) RS is widely used but may not accurately reflect risk in diverse ethnic groups.
- There is a need for a validated RS tailored to Chinese ACS patients.
Purpose of the Study:
- To develop and validate a novel risk score (CPACS RS) for in-hospital mortality in Chinese patients with acute coronary syndrome (ACS).
- To compare the performance of the new CPACS RS against the established GRACE RS in a Chinese cohort.
- To assess the accuracy and calibration of both RSs in predicting adverse outcomes.
Main Methods:
- Data from 6,790 patients in the Clinical Pathways for Acute Coronary Syndromes (CPACS) trial training set were used to develop the CPACS RS, stratified by gender.
- Discrimination and calibration of the CPACS RS and GRACE RS were evaluated on an independent validation set of 3,801 patients.
- Performance metrics including c-statistics and absolute bias were compared between the two risk scores.
Main Results:
- The CPACS RS showed significantly improved discrimination compared to the GRACE RS in both men (c-statistic 0.87 vs 0.82) and women (c-statistic 0.85 vs 0.78).
- The CPACS RS exhibited substantially lower absolute bias, indicating more accurate risk estimation than the GRACE RS, which systematically overestimated risk.
- While the GRACE RS overestimated risk, the CPACS RS showed minimal underestimation in high-risk women.
Conclusions:
- The GRACE RS significantly overestimates in-hospital mortality risk for patients with suspected ACS in China.
- The newly developed CPACS RS provides a more accurate and reliable tool for risk stratification of Chinese ACS patients.
- This study highlights the importance of developing and validating ethnicity-specific risk prediction models.
Abstract:
Currently available risk scores (RSs) were derived from populations with very few participants from China. We aimed to develop an RS based on data from patients with acute coronary syndrome in China and to compare its performance with the commonly promoted Global Registry of Acute Coronary Events (GRACE) RS. Clinical Pathways for Acute Coronary Syndromes-Phase 2 was a trial of a quality improvement intervention in China. Patients recruited from 75 hospitals from October 2007 to August 2010 were divided into training and validation sets based on immediate or delayed implementation. A Clinical Pathways for Acute Coronary Syndromes (CPACS) RS for in-hospital mortality was developed separately by gender, using the training set (6,790 patients). Discrimination and calibration of the CPACS RS and GRACE RS were compared on the validation set (3,801 patients). Although discrimination of the GRACE RS was acceptable, this was improved with the CPACS RS (c-statistic 0.82 vs 0.87, p = 0.012 for men; c-statistic 0.78 vs 0.85, p = 0.006 for women). The absolute bias was significantly lower with CPACS RS for both genders (7.6% vs 97.5% in men and 21.5% vs 77.2% in women), compared with the GRACE RS, which systematically overestimated risk. The CPACS RS underestimated risk in women, but only in those already above threshold levels currently used to define a clinical high-risk population. In conclusion, the GRACE RS substantially overestimates the risk of in-hospital death in patients presenting to the hospital with a suspected acute coronary syndrome in China. We have developed and independently validated a new RS utilizing data from Chinese patients.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations