Related Experiment Video
Updated: Jun 18, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Predictive Value of the Modified GRACE Scoring System for All-Cause Mortality in Patients with Acute Myocardial
Ju Yan1, Chang-Jiang Deng1, Si-Fan Wang1
1Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830011 Ürümqi, Xinjiang, China.
Insights
A new modified Global Registry of Acute Coronary Events (GRACE) score, incorporating B-type natriuretic peptide precursor (BNP), shows improved prediction of all-cause mortality in acute myocardial infarction (AMI) patients compared to the traditional GRACE score.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Acute myocardial infarction (AMI) poses a significant mortality risk.
- The Global Registry of Acute Coronary Events (GRACE) score is a traditional tool for risk stratification in AMI.
- Enhancing the predictive accuracy of existing scoring systems is crucial for patient management.
Purpose of the Study:
- To develop and validate a modified GRACE scoring system for improved prediction of all-cause mortality in AMI patients.
- To compare the performance of the modified GRACE score against the traditional GRACE score.
Main Methods:
- Retrospective analysis of 4561 AMI patients from January 2015 to December 2020.
- Inclusion of B-type natriuretic peptide precursor (BNP) and traditional risk factors into a modified GRACE score.
- Comparison of predictive performance using Receiver Operating Characteristic (ROC) curves and multifactorial COX regression.
Main Results:
- The modified GRACE score demonstrated a significantly higher Area Under Curve (AUC) of 0.809 compared to the traditional GRACE score's AUC of 0.786.
- Factors associated with all-cause mortality included age, cardiac function class, history of coronary artery disease, aspirin use, beta-blocker use, and the modified GRACE score.
- Integrated Discrimination Improvement (IDI) indicated a positive enhancement of the modified GRACE score over the traditional one.
Conclusions:
- The modified GRACE scoring system, incorporating BNP, offers superior predictive performance for all-cause mortality in AMI patients.
- This enhanced scoring system provides a more accurate risk stratification tool for clinical decision-making in AMI.
Background:
To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system.
Methods:
We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital's electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample t test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves.
Results:
Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample t test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, p 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, p 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant (p 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score.
Conclusions:
The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system.
Clinical Trial Registration:
NCT02737956.
