Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction

John Hung, Andreas Roos, Erik Kadesjo, David McAllister, Dorien M Kimenai, Anoop Sv Shah, Atul Anand, Fiona Strachan, Keith Fox, Nicholas Mills, Andrew Chapman, Martin Holzmann

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aims The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. Methods and results In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong’s test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82–0.85] and 0.85 (95% CI 0.81–0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70–0.77) and 0.73 (95% CI 0.66–0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P < 0.001 and P = 0.008, respectively). Conclusion The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. Trial registration number, NCT01852123.
Original languageEnglish
Article numberehaa375
Pages (from-to)1-10
JournalEuropean Heart Journal
Publication statusPublished - 9 Jun 2020

Keywords / Materials (for Non-textual outputs)

  • High-sensitivity
  • Troponin
  • Type 1 myocardial infarction
  • Type 2 myocardial infarction
  • Universal definition


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