GRACE 3.0 score better predicts in-hospital mortality risk in both men and women with NSTE-ACS, new research shows. ESCCongress
The broadly applied GRACE 2.0 has a class 1a recommendation to guide treatment in current US and European NSTE-ACS guidelines. The score was, however, derived from and validated in predominantly male populations and doesn't account for sex-based differences in the clinical characteristics of NSTE-ACS.
GRACE 3.0 was developed with the same eight GRACE 2.0 variables — age, heart rate, systolic blood pressure Killip class, creatinine concentration, cardiac arrest, presence of ST-segment deviation, and troponin elevation — but applied a machine-learning algorithm that accounts for potential nonlinear effects of baseline variables in men and women.
The discriminatory performance of the GRACE 3.0 score, however, was"remarkably better" than GRACE 2.0, reaching AUCs of 0.84 in females and 0.88 in males in the UK cohort and 0.87 and 0.91, respectively, in the Swiss external validation cohort, he said. This corresponds to a net loss of -5.2% of women previously considered low-to-intermediate risk, and a net gain of 2.2% of men in the lower risk group.
De Miguel-Balsa also highlights as limitations of the study the fact that only a third of patients were women and sex was considered solely as a binary variable.
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