Evidence map›Paper›PMID 40571489›Full record

Trial reportOpen heart2025

Effectiveness of the GRACE risk score according to troponin elevation in patients admitted with non-ST elevation acute coronary syndrome: a post hoc analysis of the UKGRIS parallel group cluster randomised controlled trial.

Chris P Gale, Deborah Stocken, Ramesh Nadarajah, Suleman Aktaa, Catherine Reynolds, Rachael Gilberts, David B Brieger, Kathryn Carruthers, Derek P Chew, Shaun Goodman and 4 more

Abstract readRandomized Controlled TrialMulticenter StudyClinical Trial, Phase III
In one paragraph

Trial report in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Chris P GaleLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK c.p.gale@leeds.ac.uk.
Deborah StockenLeeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Ramesh NadarajahLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.ORCID 0000-0001-9895-9356
Suleman AktaaDepartment of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Catherine ReynoldsLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Rachael GilbertsUniversity of Leeds Clinical Trials Research Unit, Leeds, UK.
David B BriegerCardiology, Concord Hospital, Sydney, New South Wales, Australia.ORCID 0000-0001-6115-0326
Kathryn CarruthersUniversity of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK.
Derek P ChewVictorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia.
Shaun GoodmanMedicine, St Michael's Hospital, Toronto, Ontario, Canada.
Catherine FernandezLeeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Linda SharplesMedical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Andrew T YanDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
Keith A A FoxRoyal Infirmary, Edinburgh, UK.

Funding

The British Heart Foundation CS/16/2/32145
6 · The paper itself

Abstract

backgroundThe 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 (NSTEACS) according to troponin elevation is unknown.

methodsPost hoc analysis of a phase 3 parallel group cluster randomised controlled trial (UK GRACE Risk Score, UKGRIS) of adult patients presenting with suspected NSTEACS to 42 hospitals in England between 9 March 2017 and 30 December 2019, with hospitals randomised (1:1) to standard care or according to the GRS and associated guidelines. Coprimary outcome measures were use of guideline-recommended management and time to the composite of cardiovascular death, non-fatal myocardial infarction, new-onset heart failure hospitalisation or readmission for cardiovascular event at a minimum of 24 months follow-up.

resultsA total of 3050 patients were randomised in UKGRIS, of whom 2602 had troponin elevation. The relative effect of GRS compared with standard care on the uptake of guideline-recommended care was greater for participants with troponin elevation compared with those without (relative OR 1.52, 95% CI 1.16 to 2.00, p<0.01). The time to the first composite event was not improved by the GRS among participants with (HR 0.89, 95% CI 0.70 to 1.14) or without troponin elevation (HR 1.14, 95% CI 0.79 to 1.64), with no interaction (relative HR 0.79, 95% CI 0.57 to 1.08, p=0.14 for interaction).

conclusionsFor suspected NSTEACS, the effect of the GRS compared with standard care on uptake of recommended processes in those with elevated troponin was higher than in those without. However, this did not translate into a reduction in the composite primary or secondary outcomes at 24 months. TRIAL REGISTRATION NUMBER: ISRCTN29731761.

Indexed as

Acute Coronary SyndromeNon-ST Elevated Myocardial InfarctionPatient AdmissionRegistriesTroponinAgedBiomarkersEnglandFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRisk AssessmentRisk FactorsBiomarkersTroponinCoronary AngiographyMyocardial InfarctionQuality of Health Care

Identifiers

PMID40571489
PMCPMC12207166

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Registered trials

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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.