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Validation of machine learning-based risk stratification scores for patients with acute coronary syndrome treated
Mitchel A Molenaar1,2, Jasper L Selder1,2, Amand F Schmidt1,2,3,4,5
1Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Insights
The Global Registry of Acute Coronary Events (GRACE) 3.0 score effectively predicts in-hospital mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The PRAISE score showed limited utility for predicting one-year mortality risk.
Area of Science:
- Cardiology
- Medical Informatics
- Health Services Research
Background:
- Acute coronary syndrome (ACS) requires accurate risk stratification for optimal patient management.
- Existing risk scores, such as the Global Registry of Acute Coronary Events (GRACE) 2.0, aid in predicting outcomes.
- The development of advanced predictive models, like GRACE 3.0, aims to improve mortality prediction in ACS patients.
Purpose of the Study:
- To externally validate the machine learning-based GRACE 3.0 score for in-hospital mortality prediction.
- To externally validate the PRAISE score for one-year mortality prediction.
- To compare the predictive performance of GRACE 3.0 and PRAISE against the established GRACE 2.0 score in patients with ACS treated with percutaneous coronary intervention (PCI).
Main Methods:
- External validation of GRACE 3.0 and PRAISE scores using data from ACS patients treated with PCI at a tertiary center in the Netherlands (2014-2021).
- Evaluation of GRACE 3.0 in 2759 non-ST-elevation ACS patients and PRAISE in 4347 ACS patients.
- Statistical analysis included discrimination (c-statistic) and calibration (calibration-in-the-large) assessments, alongside decision curve analysis.
Main Results:
- The GRACE 3.0 score demonstrated excellent discrimination (c-statistic 0.90) and good calibration for in-hospital mortality in NSTE-ACS patients.
- The PRAISE score showed moderate discrimination (c-statistic 0.75) and overestimated one-year mortality risk.
- Decision curve analysis indicated superior risk prediction by GRACE 3.0 compared to GRACE 2.0, whereas PRAISE did not show improvement.
Conclusions:
- The GRACE 3.0 score shows strong potential for predicting in-hospital mortality in ACS patients treated with PCI, outperforming the GRACE 2.0 score.
- The PRAISE score has limited clinical utility for predicting one-year mortality risk in this population.
- Further validation in larger, diverse cohorts, including patients not treated with PCI, is recommended to confirm these findings.
Aims:
This study aimed to validate the machine learning-based Global Registry of Acute Coronary Events (GRACE) 3.0 score and PRAISE (Prediction of Adverse Events following an Acute Coronary Syndrome) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) for predicting mortality.
Methods And Results:
Data of consecutive patients with ACS treated with PCI in a tertiary centre in the Netherlands between 2014 and 2021 were used for external validation. The GRACE 3.0 score for predicting in-hospital mortality was evaluated in 2759 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) treated with PCI. The PRAISE score for predicting one-year mortality was evaluated in 4347 patients with ACS treated with PCI. Both risk scores were compared with the GRACE 2.0 score. The GRACE 3.0 score showed excellent discrimination [c-statistic 0.90 (95% CI 0.84, 0.94)] for predicting in-hospital mortality, with well-calibrated predictions (calibration-in-the large [CIL] -0.19 [95% CI -0.45, 0.07]). The PRAISE score demonstrated moderate discrimination [c-statistic 0.75 (95% CI 0.70, 0.80)] and overestimated the one-year risk of mortality [CIL -0.56 (95% CI -0.73, -0.39)]. Decision curve analysis demonstrated that the GRACE 3.0 score offered improved risk prediction compared with the GRACE 2.0 score, while the PRAISE score did not.
Conclusion:
This study in ACS patients treated with PCI provides suggestive evidence that the GRACE 3.0 score effectively predicts in-hospital mortality beyond the GRACE 2.0 score. The PRAISE score demonstrated limited potential for predicting one-year mortality risk. Further external validation studies in larger cohorts including patients without PCI are warranted.
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