ArticleOpen heart2022
External validation of the GRACE risk score and the risk-treatment paradox in patients with acute coronary syndrome.
Article in Open heart, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction.Frontiers in cardiovascular medicine · 2022Pooled it
- Validation of the Mayo Clinic Percutaneous Coronary Intervention Risk Prediction Score in Patients With Acute Coronary Syndrome.Journal of the American Heart Association · 2025Trial
- Early EASIX and Short-Term Mortality After Acute Myocardial Infarction: A Dual-Cohort Prognostic Study.Journal of clinical medicine · 2026Article
- The Dilemma of Renal Dysfunction and Coronary Artery Revascularization: Insights From Observational Studies.JACC. Asia · 2026Article
- Lipid-lowering therapy omission at discharge and one-year outcomes after percutaneous coronary intervention: a real-world analysis of overall and elderly patients.International journal of cardiology. Heart & vasculature · 2026Article
- Longitudinal Psychosocial and Sleep Assessments for Long-Term Cardiovascular Risk Stratification after First Myocardial Infarction in Rural India.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026Article
- Stress hyperglycemia ratio improves 28-day mortality prediction beyond GRACE score in critically ill patients with acute coronary syndrome: a retrospective cohort study from MIMIC-IV.BMC cardiovascular disorders · 2026Article
- Application of HEART, GRACE 2.0 and TIMI scores for risk stratification of chest pain: a single-centre external pilot study in a Sri Lankan population.International journal of emergency medicine · 2026Article
- Linking Heat Stress to Impaired Cardiac Repair: The ER Stress-Angiogenesis Axis as a Critical Barrier.International journal of molecular sciences · 2026Review
- Sex differences in the presentation and management of acute coronary syndrome patients: Insights from the FORCE-ACS registry.International journal of cardiology. Heart & vasculature · 2026Article
- Performance of the Grace ACS Risk Score in Predicting in-Hospital and Six-Month Mortality in Patients with ACS: A Single Center Retrospective Cohort Study.Vascular health and risk management · 2026Article
- Efficacy and safety of clopidogrel and ticagrelor in acute coronary syndrome patients withResearch and practice in thrombosis and haemostasis · 2025Article
- Incorporating the STOP-BANG questionnaire improves prediction of cardiovascular events during hospitalization after myocardial infarction.Scientific reports · 2025Article
- Prediction of major adverse cardiovascular events following ST-segment elevation myocardial infarction using cardiac obesity marker-epicardial adipose tissue mass index: a prospective cohort study.Frontiers in cardiovascular medicine · 2025Article
- Acute coronary events in kidney patients: the dialysis dilemma.The British journal of cardiology · 2025Article
- Prediction of major adverse cardiovascular events following acute myocardial infarction using electrocardiogram DETERMINE score.BMC cardiovascular disorders · 2024Article
- Validation of machine learning-based risk stratification scores for patients with acute coronary syndrome treated with percutaneous coronary intervention.European heart journal. Digital health · 2024Article
- Cardiac ultrasomics for acute myocardial infarction risk stratification and prediction of all-cause mortality: a feasibility study.Echo research and practice · 2024Article
- The electronic frailty index and outcomes in patients with myocardial infarction.Age and ageing · 2024Article
- Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry.Journal of clinical medicine · 2023Article
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo validate the Global Registry of Acute Coronary Events (GRACE) risk score and examine the extent and impact of the risk-treatment paradox in contemporary patients with acute coronary syndrome (ACS).
methodsData from 5015 patients with ACS enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for model validation. The performance of the GRACE risk score for predicting in-hospital and 1-year mortality was evaluated based on indices of model discrimination and calibration. Differences in the delivery of guideline-recommended care among patients who survived hospitalisation (n=4911) per GRACE risk stratum were assessed and the association with postdischarge mortality was examined.
resultsDiscriminative power of the GRACE risk score was good for predicting in-hospital (c-statistic: 0.86; 95% CI: 0.83 to 0.90) and 1-year mortality (c-statistic: 0.82; 95% CI: 0.79 to 0.84). However, the GRACE risk score overestimated the absolute in-hospital and 1-year mortality risk (Hosmer-Lemeshow goodness-of-fit test p<0.01). Intermediate-risk and high-risk patients were 12% and 29% less likely to receive optimal guideline-recommended care compared with low-risk patients, respectively. Optimal guideline-recommended care was associated with lower mortality in intermediate- and high-risk patients.
conclusionsThe GRACE risk score identified patients at higher risk for in-hospital and 1-year mortality, but overestimated absolute risk levels in contemporary patients. Optimal guideline-recommended care was associated with lower mortality in intermediate-risk and high-risk patients, but was less likely to be delivered with increasing mortality risk.
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