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Discriminatory power of GRACE Score in NSTEMI in the real-world: Results from the Portuguese Registry on Acute Coronary Syndromes
Session:
Painel 6 - Doença Coronária 7
Speaker:
Sofia Alegria
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sofia Alegria; Ana I. Marques; Ana Rita F. Pereira; Daniel Sebaiti; Alexandra Briosa; João Grade Santos; Ana Catarina Gomes; Gonçalo Jácome Morgado; Rita Calé; Cristina Dantas Martins; Inês Rangel; Helder Pereira
Abstract
<p><strong>Introduction:</strong> Current clinical practice guidelines recommend risk stratification in patients with acute coronary syndrome upon admission to the hospital. The Global Registry of Acute Coronary Events (GRACE) risk score was developed in a large multinational registry to predict both mortality and the combined events of death or reinfarction during hospital stay and 6 months after discharge. Given the substantial regional variation and temporal changes in patient characteristics and management, specially in non-ST segment elevation myocardial infarction (NSTEMI) patients, we sought to validate this risk score in a contemporary Portuguese population.<br /> <br /> <strong>Purpose:</strong> To assess the discriminatory power of the GRACE risk score in a Portuguese contemporary cohort of patients with NSTEMI submitted to invasive strategy, regarding cardiovascular events.<br /> <br /> <strong>Methods:</strong> We included patients with NSTEMI submitted to coronary angiography from the Portuguese Registry on Acute Coronary Syndrome (ProACS). For each patient, we calculated the GRACE risk score and classified them in low, intermediate or high risk, according to the cut-offs recommended in the guidelines. The discriminatory capacity of the GRACE risk score was evaluated by the area under the receiver operating characteristic [ROC] curve. The primary endpoint was defined as the occurrence of reinfarction and/or in-hospital mortality, and the secondary endpoint was in-hospital mortality. A model with an AUC-ROC between 0.8 and 0.9 was considered to have a good discriminatory capacity.<br /> <br /> <strong>Results:</strong> Among the 19.430 patients included in the ProACS between October 2010 and January 2019, we identified 7304 patients with NSTEMI submitted to coronary angiography and with information regarding the GRACE risk score. Patients were divided in three groups according to the GRACE score (group 1: 1-108; group 2: 109-140; group 3: 141-372), with 24.9% included in group 1, 33.0% in group 2, and 42.1% in group 3. Most patients were male (73%), with a mean age of 66±12 years, and 48% were admitted to non-percutaneous coronary intervention centers. In-hospital mortality was different according to the stratification by GRACE score (group 1: 0.1%; group 2: 0.3%; group 3: 2.1%; p<0.001).</p> <p>In our population the discriminatory capacity of the GRACE score for the primary end-point was reasonable; the area under the ROC curve was 0.70 (95% CI 0.65-0.75), and the best cut-off was 164. Regarding in-hospital mortality the discriminatory capacity was good; the area under the ROC curve was 0.83 (95% confidence interval [CI], 0.78-0.88), with the best cut-off of 148.</p> <p><strong>Conclusions:</strong> The GRACE risk score was validated in our population and has a good discriminatory power regarding in-hospital mortality and a moderate discriminatory capacity for the occurrence of reinfarction and/or in-hospital mortality for patients with NSTEMI submitted to an invasive strategy.</p>
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