The Impact of Gender and Race When Using the GRACE ACS Score to Predict Mortality

Area of Science:

• Cardiology
• Clinical Risk Stratification
• Public Health

Background:

• Acute coronary syndrome (ACS) presents a major global health challenge, necessitating accurate early risk stratification.
• The Global Registry of Acute Coronary Events (GRACE) score is a validated tool for risk stratification in ACS.
• Current GRACE score lacks consideration of demographic factors like race and gender.

Purpose of the Study:

• To evaluate if incorporating gender and race enhances the predictive capability of the GRACE score for ACS patient outcomes.
• To compare the performance of the original GRACE score against a modified model including gender and race.

Main Methods:

• A retrospective cohort study involving 46,764 ACS patients from a national healthcare system.
• Comparison of the predictive accuracy using the original GRACE score versus a modified GRACE score including gender and race.
• Assessment of model accuracy via receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis.

Main Results:

• The original GRACE score demonstrated slightly superior predictive accuracy (AUC = 0.838) compared to the modified model (AUC = 0.839), with a statistically significant difference (P = .008).
• Despite statistical significance, the observed differences in AUC were minimal and potentially not clinically relevant given the large sample size.
• While gender and race showed initial associations with in-hospital mortality, these relationships were not significant in multivariate analysis.

Conclusions:

• The original GRACE score remains a valid and effective tool for predicting mortality in ACS patients.
• Inclusion of gender and race did not substantially improve the predictive performance of the GRACE score.
• Further research may explore other demographic or clinical variables for enhanced risk stratification in ACS.