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

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Web of Science)

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.

Original languageEnglish
Pages (from-to)2552-2561
Number of pages10
JournalEuropean Heart Journal
Volume42
Issue number26
DOIs
Publication statusPublished - 7 Jul 2021

Keywords

  • Type 1 myocardial infarction
  • Type 2 myocardial infarction
  • Universal definition
  • GRACE
  • High-sensitivity
  • Troponin
  • DEFINITION
  • MORTALITY
  • IMPACT

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