Observational studyBMC geriatrics2020
Frailty assessment and risk prediction by GRACE score in older patients with acute myocardial infarction.
Observational study in BMC geriatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02302014 (Randomised Trial of Early Versus Delayed Future Care Planning for Patients and Families Living With Advanced Heart Disease), which is not on this map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomised Trial of Early Versus Delayed Future Care Planning for Patients and Families Living With Advanced Heart Disease
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta-analysis.Clinical cardiology · 2023Pooled it
- The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature.Clinical interventions in aging · 2023Pooled it
- Exploratory Mixed-Data Phenomapping and Risk-Enrichment Frameworks for Long-Term Mortality After Acute Coronary Syndrome: A Single-Center Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- The cholesterol, high-density lipoprotein, and glucose (CHG) index as a novel metabolic marker for predicting adverse outcomes in myocardial infarction survivors: insights from two large prospective cohorts.Cardiovascular diabetology · 2026Article
- A composite model incorporating systemic inflammatory burden and GRACE score for enhanced identification of elevated myocardial stress in acute myocardial infarction: an exploratory analysis.Frontiers in cardiovascular medicine · 2026Article
- Prognostic value of CALLY index in combination with the GRACE score among patients with acute myocardial infarction: a retrospective cohort study.Frontiers in cardiovascular medicine · 2026Article
- A Multicohort Machine Learning Framework to Predict Mortality in Elderly Patients With Heart Disease: Insights From HARLS, SHARE, and HRS.Cardiovascular therapeutics · 2026Article
- Predicting cardiovascular outcomes in elderly patients with acute coronary syndrome: a nomogram approach.Research square · 2025Article
- The effects of invasive treatment on patients with frailty and non-ST-segment elevation myocardial infarction.Scientific reports · 2025Article
- Applied machine learning to predict 1-year major adverse cardiovascular events in elderly patients after percutaneous coronary intervention.BMC medical informatics and decision making · 2025Article
- Bridging Care Gaps for Older Women Undergoing Percutaneous Coronary Intervention.Interventional cardiology clinics · 2025Review
- Optimizing Angioplasty in Elderly Patients with Multimorbidity: A Paradigm Shift in Risk Assessment: Optimizing Angioplasty in Elderly Patients with Multimorbidity.Galen medical journal · 2025Article
- Anemia, Hyperglycemia, and Reduced Left Ventricular Ejection Fraction Improve the GRACE Score's Predictability for In-hospital Mortality in Acute Coronary Syndrome; Single-Centre Cross-Sectional Study.Open access emergency medicine : OAEM · 2025Article
- Predicting the risk of heart failure after acute myocardial infarction using an interpretable machine learning model.Frontiers in cardiovascular medicine · 2025Article
- The electronic frailty index and outcomes in patients with myocardial infarction.Age and ageing · 2024Article
- The predictive value of neutrophil-lymphocyte ratio combined with the Global Registry of Acute Coronary Events score for inhospital adverse cardiovascular events in patients with acute ST-elevation myocardial infarction.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2024Article
- Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention.Heart and vessels · 2023Article
- Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence.Journal of clinical medicine · 2023Review
- Review
- Assessment and Management of Older Adults Undergoing PCI, Part 1: AJACC. Advances · 2023Article
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
backgroundRisk prediction after myocardial infarction is often complex in older patients. The Global Registry of Acute Coronary Events (GRACE) model includes clinical parameters and age, but not frailty. We hypothesised that frailty would enhance the prognostic properties of GRACE.
methodsWe performed a prospective observational cohort study in two independent cardiology units: the Royal Infirmary of Edinburgh, UK (primary cohort) and the South Yorkshire Cardiothoracic Centre, Sheffield, UK (external validation). The study sample included 198 patients ≥65 years old hospitalised with type 1 myocardial infarction (primary cohort) and 96 patients ≥65 years old undergoing cardiac catheterisation for myocardial infarction (external validation). Frailty was assessed using the Clinical Frailty Scale (CFS). The GRACE 2.0 estimated risk of 12-month mortality, Charlson comorbidity index and Karnofsky disability scale were also determined for each patient.
resultsForty (20%) patients were frail (CFS ≥5). These individuals had greater comorbidity, functional impairment and a higher risk of death at 12 months (49% vs. 9% in non-frail patients, p < 0.001). The hazard of 12-month all-cause mortality nearly doubled per point increase in CFS after adjustment for age, sex and comorbidity (Hazard Ratio [HR] 1.90, 95% CI 1.47-2.44, p < 0.001). The CFS had good discrimination for mortality by Receiver Operating Characteristic (ROC) curve analysis (Area Under the Curve [AUC] 0.81, 95% CI 0.72-0.89) and enhanced the GRACE estimate (AUC 0.86 vs. 0.80 without CFS, p = 0.04). At existing GRACE thresholds, the CFS resulted in a Net Reclassification Improvement (NRI) of 0.44 (95% CI 0.28-0.60, p < 0.001), largely through reductions in risk estimates amongst non-frail patients. Similar findings were observed in the external validation cohort (NRI 0.46, 95% CI 0.23-0.69, p < 0.001).
conclusionsThe GRACE score overestimated mortality risk after myocardial infarction in these cohorts of older patients. The CFS is a simple guided frailty tool that may enhance prediction in this setting. These findings merit evaluation in larger cohorts of unselected patients.
trial registrationClinicaltrials.gov; NCT02302014 (November 26th 2014, retrospectively registered).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.