Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Heart. 2011 Sep;97(18):1479-83. doi: 10.1136/hrt.2010.220988. Epub 2011 Mar 28.
To compare the accuracy of the GRACE score, a strong prognosticator in acute coronary syndrome (ACS) that is calculated using conventional cardiac troponin (cTn) assays, with that calculated with high-sensitivity cTn (hs-cTn) and with the combination of the GRACE score with hs-cTn or B-type natriuretic peptide (BNP).
Prospective international cohort. Settings University Hospital.
Patients enrolled in the Predictors of Acute Coronary Syndromes Evaluation prospective study with proven ACS. Main outcome measured The capacity to predict in-hospital mortality, 1-year mortality and combined death/acute myocardial infarction (AMI) at 1 year.
370 patients were enrolled (173 with unstable angina and 197 with AMI). In-hospital mortality was 4.1%; 1-year mortality was 12.5%. The GRACE score was significantly higher in patients who died than in those discharged alive (200 (174-222) vs 125 (98-155); p<0.001), and in those who died than in those who survived for 1 year (151 (133-169) vs 104 (85-125); p<0.001). The area under the curve of the GRACE score was 0.87 regarding in-hospital mortality and 0.88 for 1-year mortality; if calculated with hs-cTn, it was 0.87 and 0.88, respectively (p=NS for all comparisons). The addition of hs-cTn to the GRACE score resulted in no increased value, whereas the addition of BNP tended to improve 1-year mortality prediction (p=0.058).
The GRACE score is accurate for determining both in-hospital and long-term mortality in patients with ACS in the era of hs-cTn. The addition of hs-cTn or BNP to the GRACE score does not significantly improve risk prediction.
比较 GRACE 评分（一种基于传统心脏肌钙蛋白（cTn）检测的急性冠状动脉综合征（ACS）强预后指标）、高敏 cTn（hs-cTn）计算的 GRACE 评分以及 GRACE 评分联合 hs-cTn 或 B 型利钠肽（BNP）在预测 ACS 患者院内死亡率、1 年死亡率和 1 年时死亡/急性心肌梗死（AMI）复合终点方面的准确性。
前瞻性国际队列研究。研究地点：大学医院。
前瞻性评估急性冠状动脉综合征预测因子研究中确诊为 ACS 的患者。主要观察指标：预测院内死亡率、1 年死亡率和 1 年时死亡/AMI 复合终点的能力。
共纳入 370 例患者（不稳定型心绞痛 173 例，AMI 197 例）。院内死亡率为 4.1%，1 年死亡率为 12.5%。死亡患者的 GRACE 评分显著高于存活出院患者（200（174-222）vs. 125（98-155）；p<0.001），也显著高于存活 1 年患者（151（133-169）vs. 104（85-125）；p<0.001）。GRACE 评分预测院内死亡率和 1 年死亡率的曲线下面积分别为 0.87 和 0.88；如果使用 hs-cTn 计算，则分别为 0.87 和 0.88（所有比较的 p 值均无统计学意义）。hs-cTn 与 GRACE 评分联合使用并未增加价值，而 BNP 的加入则倾向于改善 1 年死亡率预测（p=0.058）。
在 hs-cTn 时代，GRACE 评分可准确预测 ACS 患者的院内和长期死亡率。hs-cTn 或 BNP 与 GRACE 评分联合使用并不能显著改善风险预测。
