Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes

Area of Science:

• Cardiology
• Biomarkers
• Risk Stratification

Background:

• The Global Registry of Acute Coronary Events (GRACE) risk score is a guideline-recommended tool for acute coronary syndromes (ACS).
• The original GRACE score does not account for the extent of myocardial injury, a crucial factor in prognosis.

Purpose of the Study:

• To evaluate the added predictive value of a modified GRACE score that includes high-sensitivity cardiac troponin T (hs-cTn T) at presentation.
• To assess if hs-cTn T improves mortality risk prediction in ACS patients.

Main Methods:

• A retrospective longitudinal cohort study involving 9803 patients across three independent ACS cohorts (Heidelberg, Newcastle, SPUM-ACS).
• Two cohorts were used for derivation and one for validation of the modified GRACE score.
• The modified score incorporated continuous hs-cTn T levels, a marker of myocardial injury extent.

Main Results:

• The modified GRACE score demonstrated superior discrimination and reclassification for in-hospital, 30-day, and 1-year mortality compared to the original GRACE score.
• In the pooled population (9450 patients), the modified score showed significantly improved predictive performance across all mortality endpoints.
• Using continuous hs-cTn T improved risk prediction over binary measurements.

Conclusions:

• Incorporating continuous hs-cTn T into the GRACE risk score enhances mortality risk prediction in ACS patients.
• The modified GRACE score offers a more accurate prognostic tool by considering the extent of myocardial injury.
• This improved risk stratification can aid in clinical decision-making for ACS management.