ArticleClinical research in cardiology : official journal of the German Cardiac Society2024
GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 8 citations in OpenAlex.
- Machine Learning-Based Risk Prediction of In-Hospital Mortality in Patients With Non-ST-Elevation Acute Coronary Syndrome at Various Stages of the Diagnostic Process: Observational Study.JMIR medical informatics · 2026Observational
- Integrative transcriptomic and machine learning approach reveals key DDR genes and predictors of ami risk in the Bangladeshi population.Scientific reports · 2026Article
- Types and hospital manifestation of the "risk-treatment" paradox in non-ST-elevation acute coronary syndrome: the regional vascular centre experience.BMC cardiovascular disorders · 2025Observational
- Antithrombotic therapy for a case report of acute myocardial infarction after laparoscopic radical cystectomy.Frontiers in pharmacology · 2024Article
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Authors and funding
21 authors at 8 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn).
methodsProspectively enrolled patients presenting with symptoms suggestive of myocardial infarction (MI) in two large studies testing biomarker diagnostic strategies were included. Five GRACE risk scores were calculated. The amount of risk reclassification and the theoretical impact on guideline-recommended timing of invasive coronary angiography was studied.
resultsOverall, 8,618 patients were eligible for analyses. Comparing different GRACE risk scores, up to 63.8% of participants were reclassified into a different risk category. The proportion of MIs identified (i.e., sensitivity) dramatically differed between GRACE risk scores (range 23.8-66.5%) and was lower for any score than for the ESC 0/1 h-algorithm (78.1%). Supplementing the ESC 0/1 h-algorithm with a GRACE risk score slightly increased sensitivity (P < 0.001 for all scores). However, this increased the number of false positive results.
conclusionThe substantial amount of risk reclassification causes clinically meaningful differences in the proportion of patients meeting the recommended threshold for pursuing early invasive strategy according to the different GRACE scores. The single best test to detect MIs is the ESC 0/1 h-algorithm. Combining GRACE risk scoring with hs-cTn testing slightly increases the detection of MIs but also increases the number of patients with false positive results who would undergo potential unnecessarily early invasive coronary angiography.
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