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dc.contributor.authorElbarouni, Basem
dc.contributor.authorGoodman, Shaun G.
dc.contributor.authorYan, Raymond T.
dc.contributor.authorWelsh, Robert C.
dc.contributor.authorKornder, Jan
dc.contributor.authorDeYoung, J. Paul
dc.contributor.authorWong, Graham C.
dc.contributor.authorRose, Barry
dc.contributor.authorGrondin, Francois R.
dc.contributor.authorGallo, Richard
dc.contributor.authorTan, Mary
dc.contributor.authorCasanova, Amparo
dc.contributor.authorEagle, Kim A.
dc.contributor.authorYan, Andrew T.
dc.contributor.authorCanadian Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators
dc.date2022-08-11T08:08:09.000
dc.date.accessioned2022-08-23T15:44:18Z
dc.date.available2022-08-23T15:44:18Z
dc.date.issued2009-09-25
dc.date.submitted2011-10-20
dc.identifier.citationAm Heart J. 2009 Sep;158(3):392-9. <a href="http://dx.doi.org/10.1016/j.ahj.2009.06.010">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2009.06.010
dc.identifier.pmid19699862
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27284
dc.description.abstractBACKGROUND: The Global Registry of Acute Coronary Event (GRACE) risk score was developed in a large multinational registry to predict in-hospital mortality across the broad spectrum of acute coronary syndromes (ACS). Because of the substantial regional variation and temporal changes in patient characteristics and management patterns, we sought to validate this risk score in a contemporary Canadian population with ACS. METHODS: The main GRACE and GRACE(2) registries are prospective, multicenter, observational studies of patients with ACS (June 1999 to December 2007). For each patient, we calculated the GRACE risk score and evaluated its discrimination and calibration by the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. To assess the impact of temporal changes in management on the GRACE risk score performance, we evaluated its discrimination and calibration after stratifying the study population into prespecified subgroups according to enrollment period, type of ACS, and whether the patient underwent coronary angiography or revascularization during index hospitalization. RESULTS: A total of 12,242 Canadian patients with ACS were included; the median GRACE risk score was 127 (25th and 75th percentiles were 103 and 157, respectively). Overall, the GRACE risk score demonstrated excellent discrimination (c statistic 0.84, 95% CI 0.82-0.86, P < .001) for in-hospital mortality. Similar results were seen in all the subgroups (all c statistics >/=0.8). However, calibration was suboptimal overall (Hosmer-Lemeshow P = .06) and in various subgroups. CONCLUSIONS: GRACE risk score is a valid and powerful predictor of adverse outcomes across the wide range of Canadian patients with ACS. Its excellent discrimination is maintained despite advances in management over time and is evident in all patient subgroups. However, the predicted probability of in-hospital mortality may require recalibration in the specific health care setting and with advancements in treatment.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=19699862&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2009.06.010
dc.subjectAcute Coronary Syndrome; Aged; Canada; Cohort Studies; Female; Hospital Mortality; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; *Registries; Risk Assessment; Risk Factors
dc.subjectCardiovascular Diseases
dc.subjectHealth Services Research
dc.titleValidation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada
dc.typeJournal Article
dc.source.journaltitleAmerican heart journal
dc.source.volume158
dc.source.issue3
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace2/10
dc.identifier.contextkey2305123
html.description.abstract<p>BACKGROUND: The Global Registry of Acute Coronary Event (GRACE) risk score was developed in a large multinational registry to predict in-hospital mortality across the broad spectrum of acute coronary syndromes (ACS). Because of the substantial regional variation and temporal changes in patient characteristics and management patterns, we sought to validate this risk score in a contemporary Canadian population with ACS.</p> <p>METHODS: The main GRACE and GRACE(2) registries are prospective, multicenter, observational studies of patients with ACS (June 1999 to December 2007). For each patient, we calculated the GRACE risk score and evaluated its discrimination and calibration by the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. To assess the impact of temporal changes in management on the GRACE risk score performance, we evaluated its discrimination and calibration after stratifying the study population into prespecified subgroups according to enrollment period, type of ACS, and whether the patient underwent coronary angiography or revascularization during index hospitalization.</p> <p>RESULTS: A total of 12,242 Canadian patients with ACS were included; the median GRACE risk score was 127 (25th and 75th percentiles were 103 and 157, respectively). Overall, the GRACE risk score demonstrated excellent discrimination (c statistic 0.84, 95% CI 0.82-0.86, P < .001) for in-hospital mortality. Similar results were seen in all the subgroups (all c statistics >/=0.8). However, calibration was suboptimal overall (Hosmer-Lemeshow P = .06) and in various subgroups.</p> <p>CONCLUSIONS: GRACE risk score is a valid and powerful predictor of adverse outcomes across the wide range of Canadian patients with ACS. Its excellent discrimination is maintained despite advances in management over time and is evident in all patient subgroups. However, the predicted probability of in-hospital mortality may require recalibration in the specific health care setting and with advancements in treatment.</p>
dc.identifier.submissionpathcor_grace2/10
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages392-9


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