Sex-specific evaluation and redevelopment of the GRACE score was conducted for patients with non-ST-segment elevation acute coronary syndromes using UK and Swiss cohorts.
Does the GRACE 3.0 score improve risk stratification for in-hospital mortality in male and female patients with NSTE-ACS compared to the GRACE 2.0 score?
The GRACE 3.0 score improves upon GRACE 2.0 by accounting for sex differences, providing better discrimination for in-hospital mortality and reducing sex inequalities in risk stratification for NSTE-ACS patients.
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SummaryBackgroundThe Global Registry of Acute Coronary Events (GRACE) 2.0 score was developed and validated in predominantly male patient populations. We aimed to assess its sex-specific performance in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and to develop an improved score (GRACE 3.0) that accounts for sex differences in disease characteristics.MethodsWe evaluated the GRACE 2.0 score in 420 781 consecutive patients with NSTE-ACS in contemporary nationwide cohorts from the UK and Switzerland. Machine learning models to predict in-hospital mortality were informed by the GRACE variables and developed in sex-disaggregated data from 386 591 patients from England, Wales, and Northern Ireland (split into a training cohort of 309 083 80·0% patients and a validation cohort of 77 508 20·0% patients). External validation of the GRACE 3.0 score was done in 20 727 patients from Switzerland.FindingsBetween Jan 1, 2005, and Aug 27, 2020, 400 054 patients with NSTE-ACS in the UK and 20 727 patients with NSTE-ACS in Switzerland were included in the study. Discrimination of in-hospital death by the GRACE 2.0 score was good in male patients (area under the receiver operating characteristic curve AUC 0·86, 95% CI 0·86–0·86) and notably lower in female patients (0·82, 95% CI 0·81–0·82; pInterpretationThe GRACE 2.0 score has limited discriminatory performance and underestimates in-hospital mortality in female patients with NSTE-ACS. The GRACE 3.0 score performs better in men and women and reduces sex inequalities in risk stratification.FundingSwiss National Science Foundation, Swiss Heart Foundation, Lindenhof Foundation, Foundation for Cardiovascular Research, and Theodor-Ida-Herzog-Egli Foundation.
Wenzl et al. (Mon,) reported a other. Sex-specific evaluation and redevelopment of the GRACE score was conducted for patients with non-ST-segment elevation acute coronary syndromes using UK and Swiss cohorts.