The GRACE score's performance in predicting in-hospital and 1-year outcome in the era of high-sensitivity cardiac troponin assays and B-type natriuretic peptide.

Abstract

OBJECTIVE:

To compare the accuracy of the GRACE score, a strong prognosticator in acute coronary syndrome (ACS) that is calculated using conventional cardiac troponin (cTn) assays, with that calculated with high-sensitivity cTn (hs-cTn) and with the combination of the GRACE score with hs-cTn or B-type natriuretic peptide (BNP).

DESIGN:

Prospective international cohort. Settings University Hospital.

PATIENTS:

Patients enrolled in the Predictors of Acute Coronary Syndromes Evaluation prospective study with proven ACS. Main outcome measured The capacity to predict in-hospital mortality, 1-year mortality and combined death/acute myocardial infarction (AMI) at 1 year.

RESULTS:

370 patients were enrolled (173 with unstable angina and 197 with AMI). In-hospital mortality was 4.1%; 1-year mortality was 12.5%. The GRACE score was significantly higher in patients who died than in those discharged alive (200 (174-222) vs 125 (98-155); p<0.001), and in those who died than in those who survived for 1 year (151 (133-169) vs 104 (85-125); p<0.001). The area under the curve of the GRACE score was 0.87 regarding in-hospital mortality and 0.88 for 1-year mortality; if calculated with hs-cTn, it was 0.87 and 0.88, respectively (p=NS for all comparisons). The addition of hs-cTn to the GRACE score resulted in no increased value, whereas the addition of BNP tended to improve 1-year mortality prediction (p=0.058).

CONCLUSION:

The GRACE score is accurate for determining both in-hospital and long-term mortality in patients with ACS in the era of hs-cTn. The addition of hs-cTn or BNP to the GRACE score does not significantly improve risk prediction.

• Authors: Christophe Meune, Beatrice Drexler, Philip Haaf, Tobias Reichlin, Miriam Reiter, Julia Meissner, Raphael Twerenbold, Claudia Stelzig, Michael Freese, Katrin Winkler, Christian Mueller
• Journal: Heart (British Cardiac Society) (Heart) Vol. 97 Issue 18 Pg. 1479-83 (Sep 2011) ISSN: 1468-201X [Electronic] England
• PMID: 21444339 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Troponin
• Natriuretic Peptide, Brain

Topics

• Acute Coronary Syndrome (diagnosis, mortality)
• Aged
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Prognosis
• Prospective Studies
• Treatment Outcome
• Troponin (blood)