Validation of GRACE score (Global Registry of Acute Coronary Events) as a predictor of in hospital mortality in acute coronary syndromes in Buenos Aires

Brenda N. Mangariello, Patricia C. Gitelman

Abstract


Background: GRACE score (G) estimates in-hospital mortality risk (IHM) in patients with acute coronary syndromes (ACS).Given the variability of patients´ characteristics, health systems, socioeconomic environment and changes in treatment; external validation should be performed. The TRIPOD statement was published to standardize validation studies´ methodology. The objective of this study is to asses if G predicts IHM with precision in patients with acute coronary syndrome at Juan A. Fernández Hospital (validation cohort -V-).Methods: Retrospective validation study. Consecutive patients admitted between 2001 and 2016 were included. Discriminationwas evaluated using the area under the ROC curve (AUC) and calibration was evaluated using de Hosmer-Lemeshowtest, calibration-in-the-large, calibration slope, validation graph and calibration belt. Subgroup analysis by type of ACS wasperformed.

Results: A total of 2104 patients were analyzed. Myocardial infarction with ST elevation (40.4% and 32%) and IHM (5.56%and 4.6%) was more prevalent than G estimation. Calibration was poor, risks were underestimated between probabilities of3 and 13%. The calibration slope was adequate, therefore the overall effect and magnitude of predictors on IHM was similarto G. The AUC was 0.86. The model performed with underestimation of risk between probabilities of 5% and 23% in patientswith ACS and ST elevation, the discrimination was good. Calibration and discrimination performed well in patients withnon ST elevation ACS.

Conclusions: Despite the lack of statistical validity of the model in the total population, the variables were predictors of IHMin the validation cohort. Therefore, G score is clinically relevant, but should be recalibrated in our population.


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