Key result
GRACE score predicts in-hospital mortality in very elderly ACS patients as accurately as younger cohorts.
Why the study?
The GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented, raising uncertainty about its accuracy in very elderly ACS patients.
Does the GRACE score accurately predict in-hospital mortality in octogenarians and nonagenarians with acute coronary syndromes?
Observational (n=994)
No
Does the GRACE score accurately predict in-hospital mortality in octogenarians and nonagenarians with acute coronary syndromes?
The GRACE score is highly accurate and well-calibrated for predicting in-hospital mortality in very elderly patients (≥80 years) with ACS, performing similarly to younger patients.
Answers are grounded in this paper and cite their sources.
GRACE score shows good discrimination and calibration for in-hospital ACS mortality in very elderly patients; extends validation to this group but leaves clinical adoption open.
BACKGROUND: The GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented. OBJECTIVE: To test the accuracy of the GRACE score in predicting in-hospital mortality of very elderly individuals with acute coronary syndromes (ACS). METHODS: Prospective observational study conducted in the intensive coronary care unit of a tertiary center from September 2011 to August 2016. Patients consecutively admitted due to ACS were selected, and the very elderly group was defined by age ≥ 80 years. The GRACE Score was based on admission data and its accuracy was tested regarding prediction of in-hospital death. Statistical significance was defined by p value < 0,05. RESULTS: A total of 994 individuals was studied, 57% male, 77% with non-ST elevation myocardial infarction and 173 (17%) very elderly patients. The mean age of the sample was 65 ± 13 years, and the mean age of very elderly patients subgroup was 85 ± 3.7 years. The C-statistics of the GRACE Score in very elderly patients was 0.86 (95% CI = 0.78 - 0.93), with no difference when compared to the value for younger individuals 0.83 (95% CI = 0.75 - 0.91), with p = 0.69. The calibration of the score in very elderly patients was described by χ2 test of Hosmer-Lemeshow = 2.2 (p = 0.98), while the remaining patients presented χ2 = 9.0 (p = 0.35). Logistic regression analysis for death prediction did not show interaction between GRACE Score and variable of very elderly patients (p = 0.25). CONCLUSION: The GRACE Score in very elderly patients is accurate in predicting in-hospital ACS mortality, similarly to younger patients.
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Cerqueira et al. (2017) conducted an observational in Acute coronary syndromes (n=994). GRACE Score vs. Younger individuals (age < 80 years) was evaluated on Prediction of in-hospital death (C-statistic) (p=0.69). The GRACE Score accurately predicted in-hospital mortality in very elderly patients with ACS (C-statistic 0.86; 95% CI 0.78-0.93), with no significant difference compared to younger patients (P=0.69).
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