Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction

John Hung, Andreas Roos, Erik Kadesjö, David A McAllister, Dorien M Kimenai, Anoop S V Shah, Atul Anand, Fiona E Strachan, Keith A A Fox, Nicholas L Mills, Andrew R Chapman, Martin J Holzmann, John Hung, Andreas Roos, Erik Kadesjö, David A McAllister, Dorien M Kimenai, Anoop S V Shah, Atul Anand, Fiona E Strachan, Keith A A Fox, Nicholas L Mills, Andrew R Chapman, Martin J Holzmann

Abstract

Aims: The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain.

Methods and results: In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong's test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82-0.85] and 0.85 (95% CI 0.81-0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70-0.77) and 0.73 (95% CI 0.66-0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P < 0.001 and P = 0.008, respectively).

Conclusion: The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction.

Trial registration: ClinicalTrials.gov number, NCT01852123.

Keywords: GRACE; High-sensitivity; Troponin; Type 1 myocardial infarction; Type 2 myocardial infarction; Universal definition.

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1
Figure 1
Comparison of the discrimination of the GRACE score for the prediction of all-cause mortality in patients with type 1 (red) and type 2 (blue) myocardial infarction using the area under the receiver operator characteristic curve, in the Scottish and Swedish cohorts.
Figure 2
Figure 2
Evaluation of the calibration of the GRACE score for the prediction of all-cause mortality in patients with type 1 (red) and type 2 (blue) myocardial infarction, using the observed rate of events vs. the predicted rate of events, in the Scottish and Swedish cohorts. Each dot represents one decile of risk.
Figure 3
Figure 3
Comparison of survival free from death in patients with type 1 and type 2 myocardial infarction grouped by GRACE risk category (low risk

Take home figure

Performance of the GRACE…

Take home figure

Performance of the GRACE 2.0 score in patients with type 1 and…

Take home figure
Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction.
Take home figure
Take home figure
Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction.

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