Long-term prognostic ability of the GRACE 3.0 risk score in patients hospitalized for acute coronary syndromes

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The GRACE 3.0 (GRS 3.0) is a risk assessment tool for in hospital mortality for patients admitted with acute coronary syndrome (ACS). This study sought to validate the accuracy of GRS 3.0 in predicting long-term mortality following a hospitalization for ACS.

We measured retrospectively all various factors included in GRS 3.0 such as age, heart rate, systolic blood pressure, creatinine, sex, cardiac arrest, ST-segment deviation on ECG, troponin elevation, and Killip Class. Multivariable Cox regression analysis was used. The discriminative ability of the GRACE 3.0 risk score was calculated by the c-index, which corresponds to the area under the ROC curve.

223 patients with ACS were included. During a median follow-up of 3 years, 57 (25.6%) patients died. Among the variables of GRS 3.0, age, heart rate, and troponin elevation at admission were the only independent predictors of mortality. The score had good discrimination for all-cause mortality (c-index=0.82, 95% CI 0.75–0.89) [Figure]. It performed equally well in both sexes.

The newly developed GRS 3.0 is well-performing for predicting long-term mortality in patients hospitalized for ACS. Thus, it may assist in tailored risk stratification and management of these patients following hospital discharge.