Validation of the GRACE risk score for predicting death within 6 months of follow-up in a contemporary cohort of patients with acute coronary syndrome.

INTRODUCTION AND
OBJECTIVES: The Global Registry of Acute Coronary Events (GRACE) risk score provides an estimate of the probability of death within 6 months of hospital discharge in patients with acute coronary syndrome (ACS). Our aim was to assess the validity of this risk score in a contemporary cohort of patients admitted to a Spanish hospital.
METHODS: The study involved 1,183 consecutive patients with ACS evaluated between February 2004 and February 2009. Their vital status was determined 6 months after hospital discharge and the validity of the GRACE risk score was evaluated by assessing its calibration (Hosmer-Lemeshow test) and its discriminatory capacity (area under the receiver operating characteristic [ROC] curve).
RESULTS: In total, 459 (38.8%) patients were admitted for ST-elevation myocardial infarction (STEMI) and 724 (61.2%) for non-ST-elevation myocardial infarction (NSTEMI). Percutaneous revascularization was performed in 846 (71.5%). The median GRACE risk score was 121 [interquartile range, 96-144]. Mortality 6 months after discharge was 4.4%. The calibration of the GRACE risk score was acceptable (Hosmer-Lemeshow, P>.2) and its discriminatory capacity was excellent: the area under the ROC curve was 0.86 (95% confidence interval [CI], 0.807-0.916) for all patients, 0.9 (95% CI, 0.829-0.975) for those with STEMI and 0.86 (95% CI, 0.783-0.927) for those with NSTEMI.
CONCLUSIONS: The GRACE risk score for predicting death within 6 months of hospital discharge was validated and can be used in patients with ACS. It would be wise to include the GRACE risk score in the medical records of these patients.