Original title: Walking Beyond the GRACE (Global Registry of Acute Coronary Events) Model in the Death Risk Stratification During Hospitalization in Patients With Acute Coronary Syndrome. Reference: Rapouseiras-Roubín S, et al. J Am Coll Cardiol Intv 2012;5:1117–25.

Discriminatory power of risk score predictors become fundamental in the management of patients with acute coronary syndromes. This tool lets you define, for example, which patients will benefit most from more aggressive strategies such as early percutaneous revascularization.

Accordingly, several risk scores have been proposed. One of the most widely used in medical practice, the GRACE score, was drafted in 2003 and rapidly became popular owing to its wide applicability. Another widely used score is the one we set in this context; ACTION.

The aim of this study in a single center in Spain was to compare the predictive ability of traditional risk scores, (GRACE and ACTION), with more contemporary scores, (EHS and NCDR). 4,497 consecutive patients were included, of whom 32.1% had MI with ST-segment elevation. Traditional scores from the predictors GRACE and ACTION showed an excellent performance in predicting. Additionally, the more recent prediction scores from NCDR and EHS were not superior to the traditional in this context.

Conclusion 

The GRACE score remains a tool with great clinical applicability for the prediction of adverse cardiovascular events in patients with acute coronary syndromes.

Editorial Comment:

The major limitation of the study lies in the fact it came from a single center whose inclusion of patients was performed consecutively. However, the significant number of patients included allows generalizing the conclusion (external validity) that the GRACE score remains one of the most useful tools for predicting cardiovascular risk in patients with acute coronary syndromes.

Courtesy of Dr. Marco Wainstein
Editorial Board Member

Dr. Marco Wainstein