Trial reportBMJ (Clinical research ed.)2023
Effectiveness of GRACE risk score in patients admitted to hospital with non-ST elevation acute coronary syndrome (UKGRIS): parallel group cluster randomised controlled trial.
Trial report in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations II: diagnostic tests and prediction models.European heart journal · 2025Guideline
- Definitions of clinical study outcome measures for cardiovascular diseases: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart).European heart journal · 2025Pooled it
- Trial
- Risk Stratification in Cardiovascular Medicine for Prognostic Assessment and Therapeutic Decision-Making: From Atrial Fibrillation to the Broader Disease Spectrum.Journal of arrhythmia · 2026Review
- Association of metabolic dysfunction-associated steatotic liver disease with coronary plaque vulnerability and prognosis in patients with acute coronary syndrome.BMC cardiovascular disorders · 2026Article
- Non-ST-Elevation Myocardial Infarction: A Heterogeneous Syndrome with Evolving Management-A Narrative Review.Biomedicines · 2026Review
- 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
- Machine learning redevelopment of GRACE, ACEF, and TIMI scores for 6-month mortality.Frontiers in artificial intelligence · 2026Article
- Value of hs-cTnT, sST2, and Lp-PLA2 in the classification of acute coronary syndrome.Experimental and therapeutic medicine · 2025Article
- Unsupervised machine learning for cardiovascular disease: A framework for future studies.European journal of heart failure · 2025Review
- Impact of Risk Stratification on Clinical Outcomes in Patients With Acute Coronary Syndrome - A Systematic Review.Circulation reports · 2025Article
- Bioelectrical impedance analysis for evaluation of adverse cardiovascular events in patients with acute coronary syndromes: a prospective cohort study.International journal of emergency medicine · 2025Article
- Acute coronary syndromes: mechanisms, challenges, and new opportunities.European heart journal · 2025Review
- Multiple biomarkers risk score for accurately predicting the long-term prognosis of patients with acute coronary syndrome.Journal of geriatric cardiology : JGC · 2025Article
- Non-invasive scoring systems of liver fibrosis predict prognosis in the cohort with myocardial infarction.Scientific reports · 2025Article
- Expanding risk stratification in acute coronary syndromes with systemic indices: HALP and CALLY.Biomarkers in medicine · 2025Article
- Phenotypic characterization of people at risk of atrial fibrillation: protocol for the FIND-AF longitudinal cohort study.European journal of preventive cardiology · 2024Article
- Acute myocardial infarction prognosis prediction with reliable and interpretable artificial intelligence system.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Adapting power calculations to include a superiority margin: what are the implications?Biochemia medica · 2024Review
- How should a cluster randomized trial be analyzed?Journal of epidemiology and population health · 2024Article
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 3 countries.
Funding
Abstract
objectiveTo determine the effectiveness of risk stratification using the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) for patients presenting to hospital with suspected non-ST elevation acute coronary syndrome.
designParallel group cluster randomised controlled trial.
settingPatients presenting with suspected non-ST elevation acute coronary syndrome to 42 hospitals in England between 9 March 2017 and 30 December 2019.
participantsPatients aged ≥18 years with a minimum follow-up of 12 months.
interventionHospitals were randomised (1:1) to patient management by standard care or according to the GRS and associated guidelines.
main outcome measuresPrimary outcome measures were use of guideline recommended management and time to the composite of cardiovascular death, non-fatal myocardial infarction, new onset heart failure hospital admission, and readmission for cardiovascular event. Secondary measures included the duration of hospital stay, EQ-5D-5L (five domain, five level version of the EuroQoL index), and the composite endpoint components.
results3050 participants (1440 GRS, 1610 standard care) were recruited in 38 UK clusters (20 GRS, 18 standard care). The mean age was 65.7 years (standard deviation 12), 69% were male, and the mean baseline GRACE scores were 119.5 (standard deviation 31.4) and 125.7 (34.4) for GRS and standard care, respectively. The uptake of guideline recommended processes was 77.3% for GRS and 75.3% for standard care (odds ratio 1.16, 95% confidence interval 0.70 to 1.92, P=0.56). The time to the first composite cardiac event was not significantly improved by the GRS (hazard ratio 0.89, 95% confidence interval 0.68 to 1.16, P=0.37). Baseline adjusted EQ-5D-5L utility at 12 months (difference -0.01, 95% confidence interval -0.06 to 0.04) and the duration of hospital admission within 12 months (mean 11.2 days, standard deviation 18 days
conclusionsIn adults presenting to hospital with suspected non-ST elevation acute coronary syndrome, the GRS did not improve adherence to guideline recommended management or reduce cardiovascular events at 12 months.
trial registrationISRCTN 29731761.
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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.