Evaluation of the performance of the GRACE risk score in predicting long-term mortality in Tunisian patient presenting with non-ST-elevation acute coronary syndrome - 25/09/20
Résumé |
Introduction |
The Global Registry of Acute Coronary Events (GRACE) risk score is recommended in international guidelines for the risk stratification of non-ST-elevation acute coronary syndome (NSTE-ACS) for in-hospital and 6-month mortality. There is currently no validated risk model to predict mortality beyond 6 months in Tunisian context.
Objective |
We aimed to evaluate the performance of the GRACE risk score in predicting in-hospital, 6-month, 1-year and 3-year mortality.
Method |
In this retrospective single center cohort study, all consecutive patients admitted to our department for NSTE-ACS from April 2014 to July 2016 were enrolled. Follow-up at 6 months, 1 year and 3 years was reported. The GRACE risk score was calculated for all patients and its discriminative performance for mortality prediction evaluated by means of area under the receiver operating curve (AUC).
Results |
A total of 340 patients were included. Mean age was 65.2±12.7years, 61.8% were male, prevalence of diabetes mellitus and hypertension was 57.3% and 65.9%, respectively. Upon admission, 57% of patients had positive troponin assay and 13.5% had a GRACE score>140. An invasive strategy was adopted in 86.2% of our patients and revascularization was proposed for 71.2% of them. In-hospital, 1-year and 3-year mortality were 2.35%, 3.2%, 7.6% and 15.2%, respectively. The performance of the GRACE risk score was not good for in-hospital mortality (AUC=0.681 95% CI: 0.55–0.82, P=0.2) probably due to the low mortality rate. The model performed well in 6-month mortality (AUC=0.879, 95% CI: 0.82–0.93, P<0.001), in 12-month mortality (AUC=0.853, 95% CI: 0.77–0.92, P<0.001) and in 3-year mortality (AUC=0.879, 95% CI: 0.83–0.92, P<0.001).
Conclusion |
In our context, the GRACE postdischarge risk score accurately discriminate mortality over the longer term (up to 3years) in all subsets of NSTE-ACS patients, and thus may be used in our practice.
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Vol 12 - N° 2-4
P. 226 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.