Key result
The GRACE risk score demonstrated good overall discrimination for predicting 6-month death or reinfarction in AMI patients aged ≥80 years (C-statistic 0.708; 95% CI 0.655-0.760; P<0.001).
Why the study?
Does the GRACE risk score accurately predict 6-month death or reinfarction in Chinese AMI inpatients aged 80 years and older?
Observational (n=370)
Does the GRACE risk score accurately predict 6-month death or reinfarction in Chinese AMI inpatients aged 80 years and older?
The GRACE risk score is a valid tool for predicting 6-month death or reinfarction in Chinese AMI patients aged 80 and older, though discrimination is lower in STEMI compared to non-STEMI.
Answers are grounded in this paper and cite their sources.
May support GRACE stratification in elderly Chinese AMI inpatients; leaves open external validation and calibration before broader use.
INTRODUCTION AND OBJECTIVE: The Global Registry of Acute Coronary Events (GRACE) risk score provides a prediction of the probability of death and myocardial infarction within 6 months after acute coronary syndrome. Our aim was to detect the validity of the GRACE risk score in predicting 6-month death or reinfarction in Chinese acute myocardial infarction (AMI) inpatients 80 years of age and older between 2003 and 2012. METHODS: Using the GRACE risk score to predict the combined endpoints of all-cause death or reinfarction within 6 months of AMI, we evaluated its discrimination and calibration by the C-statistic and the Hosmer-Lemeshow test, respectively. RESULTS: In total, 370 patients presenting with ST segment elevation myocardial infarction (STEMI) and non-STEMI were included. The GRACE risk score ranged between 181 and 325; death or reinfarction within 6 months of AMI was 49.2%. The GRACE model showed good discrimination overall (C-statistic 0.708, 95% confidence interval: 0.655-0.760, P<0.001) and in patients with non-STEMI (C-statistic 0.756, 95% confidence interval: 0.690-0.823, P<0.001). However, the discriminatory capacity was lower in patients with STEMI (C-statistic 0.645, P=0.001). The calibration was optimal overall (Hosmer-Lemeshow, P=0.398) and in the subgroups (STEMI, P=0.098; non-STEMI, P=0.822). There was a high correlation (R=0.926) between the predicted and the observed 6-month death or reinfarction after AMI. CONCLUSION: The GRACE score is accurate for determination of 6-month death or reinfarction in Chinese AMI inpatients 80 years of age and older; however, the discrimination and calibration performs less well in patients with STEMI.
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Luo et al. (2013) conducted an observational in acute myocardial infarction (n=370). GRACE risk score was evaluated on all-cause death or reinfarction within 6 months (C-statistic 0.708, 95% CI 0.655-0.760, p=<0.001). The GRACE risk score demonstrated good overall discrimination for predicting 6-month death or reinfarction in AMI patients aged ≥80 years (C-statistic 0.708; 95% CI 0.655-0.760; P<0.001).
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