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- Title
Ethnicity-dependent performance of the Global Registry of Acute Coronary Events risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: nationwide cohort study.
- Authors
Moledina, Saadiq M; Kontopantelis, Evangelos; Wijeysundera, Harindra C; Banerjee, Shrilla; Spall, Harriette G C Van; Gale, Chris P; Shah, Benoy N; Mohamed, Mohamed O; Weston, Clive; Shoaib, Ahmad; Mamas, Mamas A
- Abstract
Aims The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with the acute coronary syndrome with or without ST-segment elevation. Little is known about its performance at predicting in-hospital mortality for ethnic minority patients. Methods and results We identified 326 160 admissions with non-ST-segment elevation myocardial infarction (NSTEMI) in the Myocardial Infarction National Audit Project (MINAP), 2010–17, including White (n = 299 184) and ethnic minorities (excluding White minorities) (n = 26 976). We calculated the GRACE score for in-hospital mortality and assessed ethnic group baseline characteristics by low, intermediate and high risk. The performance of the GRACE risk score was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration (calibration plots). Ethnic minorities presented younger and had increased prevalence of cardiometabolic risk factors in all GRACE risk groups. The GRACE risk score for White [AUC 0.87, 95% confidence interval (CI) 0.86–0.87] and ethnic minority (AUC 0.87, 95% CI 0.86–0.88) patients had good discrimination. However, whilst the GRACE risk model was well calibrated in White patients (expected to observed (E : O) in-hospital death rate ratio 0.99; slope 1.00), it overestimated risk in ethnic minority patients (E : O ratio 1.29; slope: 0.94). Conclusion The GRACE risk score provided good discrimination overall for in-hospital mortality, but was not well calibrated and overestimated risk for ethnic minorities with NSTEMI.
- Subjects
DISEASE risk factors; MYOCARDIAL infarction; HOSPITAL mortality; RECEIVER operating characteristic curves; ACUTE coronary syndrome
- Publication
European Heart Journal, 2022, Vol 43, Issue 24, p2289
- ISSN
0195-668X
- Publication type
Article
- DOI
10.1093/eurheartj/ehac052