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Performance of the Grace ACS Risk Score in Predicting in-Hospital and Six-Month Mortality in Patients with ACS: A
Albert F Nyanga1, Jeilan Mohamed1, Miriam Msunza1
1Section of Cardiology, Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya.
Insights
The GRACE 2 score effectively predicts in-hospital mortality for acute coronary syndromes (ACS) in Africa. However, it is less accurate for predicting 6-month mortality in this patient population.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary heart disease (CHD) incidence is increasing globally, with a significant burden in Africa.
- Risk stratification for acute coronary syndromes (ACS) in African populations remains understudied.
- Understanding regional outcomes is crucial for effective CHD management.
Purpose of the Study:
- To evaluate the performance of the GRACE 2 score in predicting outcomes for patients with ACS in a tertiary African hospital.
- To assess the score's accuracy for both in-hospital and 6-month post-discharge mortality.
Main Methods:
- A single-center retrospective cohort study of 378 patients with ACS.
- Descriptive statistics were used for data summarization.
- Logistic regression and AUROC curves analyzed the GRACE 2 score's predictive capacity for mortality.
Main Results:
- The GRACE 2 score showed good discriminative power (AUROC 0.87) for in-hospital mortality.
- In-hospital mortality was 2.11%, with higher rates for STEMI (3.72%) versus NSTEMI (0.55%).
- The score's accuracy for 6-month mortality (AUROC 0.66) was insufficient.
Conclusions:
- The GRACE 2 score is a valuable tool for predicting in-hospital mortality in ACS patients in this African setting.
- The score's utility is limited for predicting longer-term (6-month) mortality.
- Further research is needed to refine risk stratification models for ACS in African populations.
Introduction:
The incidence of coronary heart disease (CHD) is rising globally. Despite the high burden of CHD in Africa, little is known about appropriate risk stratification systems that can be used to predict outcomes in patients with acute coronary syndromes (ACS) in this region.
Methodology:
This was a single-center retrospective cohort study conducted at the Aga Khan University hospital. Data was explored descriptively by summarizing categorical variables using frequencies/percentages and continuous variables using medians and interquartile ranges. Risk groups and mortality were compared using Fisher's exact test or the chi-square test. The area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were obtained from a binary logistic regression model with mortality as the outcome of interest. The model fit was assessed using Hosmer-Lemeshow statistics. Analysis was performed using R version 4.3.2 (2023-10-31 ucrt) and p-value < 0.05 set as statistical significance.
Results:
378 participants were enrolled. NSTEMI was diagnosed in 48.4% of participants and STEMI in 51.6%. ACS in-hospital mortality was 2.11% and 6-months mortality was 12.70%. NSTEMI in-hospital mortality was 0.55% (p = 0.45) and 15.92% (p = 0.028) at 6-months. STEMI in-hospital mortality was 3.72% (p < 0.001) and 18.23% (p < 0.001) at 6-months. The AUROC curve for in-hospital mortality was 0.87 and 0.66 for 6-month mortality, demonstrating acceptable discriminatory capacity. Calibration of the score using the Hosmer-Lemeshow model fit was appropriate (p = 0.999).
Conclusion:
The GRACE 2 score demonstrated good discriminative power and an acceptable goodness-of-fit for in-hospital outcomes in our setting, but was insufficiently accurate for reliably predicting 6-month post-discharge mortality.
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