This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (197)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Estimating the Risk of 6-Month Postdischarge Death in an International Registry

Kim A. Eagle, MD; Michael J. Lim, MD; Omar H. Dabbous, MD, MPH; Karen S. Pieper, MS; Robert J. Goldberg, PhD; Frans Van de Werf, MD, PhD; Shaun G. Goodman, MD, MSc; Christopher B. Granger, MD; P. Gabriel Steg, MD; Joel M. Gore, MD; Andrzej Budaj, MD, PhD; Álvaro Avezum, MD, PhD; Marcus D. Flather, MBBS, FRCP; Keith A. A. Fox, MB, ChB, FRCP; for the GRACE Investigators

JAMA. 2004;291:2727-2733.

Context  Accurate estimation of risk for untoward outcomes after patients have been hospitalized for an acute coronary syndrome (ACS) may help clinicians guide the type and intensity of therapy.

Objective  To develop a simple decision tool for bedside risk estimation of 6-month mortality in patients surviving admission for an ACS.

Design, Setting, and Patients  A multinational registry, involving 94 hospitals in 14 countries, that used data from the Global Registry of Acute Coronary Events (GRACE) to develop and validate a multivariable stepwise regression model for death during 6 months postdischarge. From 17 142 patients presenting with an ACS from April 1, 1999, to March 31, 2002, and discharged alive, 15 007 (87.5%) had complete 6-month follow-up and represented the development cohort for a model that was subsequently tested on a validation cohort of 7638 patients admitted from April 1, 2002, to December 31, 2003.

Main Outcome Measure  All-cause mortality during 6 months postdischarge after admission for an ACS.

Results  The 6-month mortality rates were similar in the development (n = 717; 4.8%) and validation cohorts (n = 331; 4.7%). The risk-prediction tool for all forms of ACS identified 9 variables predictive of 6-month mortality: older age, history of myocardial infarction, history of heart failure, increased pulse rate at presentation, lower systolic blood pressure at presentation, elevated initial serum creatinine level, elevated initial serum cardiac biomarker levels, ST-segment depression on presenting electrocardiogram, and not having a percutaneous coronary intervention performed in hospital. The c statistics for the development and validation cohorts were 0.81 and 0.75, respectively.

Conclusions  The GRACE 6-month postdischarge prediction model is a simple, robust tool for predicting mortality in patients with ACS. Clinicians may find it simple to use and applicable to clinical practice.

Author Affiliations: Department of Internal Medicine, University of Michigan Health System, Ann Arbor (Drs Eagle and Lim); Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Dabbous, Goldberg, and Gore); Department of Medicine, Duke University Medical Center, Durham, NC (Dr Granger and Ms Pieper); Department of Cardiology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium (Dr Van de Werf); Canadian Heart Research Centre and Terrence Donnelly Heart Centre, and Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario (Dr Goodman); Cardiology, Hôpital Bichat, Paris, France (Dr Steg); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (Dr Budaj); Clinical Research Center, Education, and Research Institute Hospital Albert Einstein, São Paulo, Brazil (Dr Avezum); Royal Brompton and Harefield NHS Trust, London, England (Dr Flather); and The University and The Royal Infirmary of Edinburgh, Edinburgh, Scotland (Dr Fox).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Human Studies of Angiogenic Gene Therapy
Gupta et al.
Circ. Res. 2009;105:724-736.
ABSTRACT | FULL TEXT  

Acute Coronary Syndromes: Diagnosis and Management, Part I
Kumar and Cannon
Mayo Clin Proc. 2009;84:917-938.
ABSTRACT | FULL TEXT  

Baseline heart rate, antihypertensive treatment, and prevention of cardiovascular outcomes in ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial).
Poulter et al.
J Am Coll Cardiol 2009;54:1154-1161.
ABSTRACT | FULL TEXT  

Is Depression After an Acute Coronary Syndrome Simply a Marker of Known Prognostic Factors for Mortality?
Kronish et al.
Psychosom. Med. 2009;71:697-703.
ABSTRACT | FULL TEXT  

A step further with ivabradine: SIGNIfY (Study assessInG the morbidity-mortality beNefits of the If inhibitor ivabradine in patients with coronarY artery disease)
Ferrari
Eur Heart J Suppl 2009;11:D19-D27.
ABSTRACT | FULL TEXT  

Heart rate management in coronary artery disease: the CLARIFY registry
Steg
Eur Heart J Suppl 2009;11:D13-D18.
ABSTRACT | FULL TEXT  

Variation on a Theme: CMR as the "One-Stop Shop" for Risk Stratification After Infarction?
Wu
J Am Coll Cardiol Img 2009;2:843-845.
FULL TEXT  

Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events
Brieger et al.
Heart 2009;95:888-894.
ABSTRACT | FULL TEXT  

Optimal Management of Acute Coronary Syndromes
Hillis and Lange
NEJM 2009;360:2237-2240.
FULL TEXT  

Growth differentiation factor-15 as a prognostic marker in patients with acute myocardial infarction
Khan et al.
Eur Heart J 2009;30:1057-1065.
ABSTRACT | FULL TEXT  

Stopping the Hemorrhage: A New Baseline Bleeding Score Brings Us a Step Closer for Patients With Non-ST-Elevation Myocardial Infarction
Anderson
Circulation 2009;119:1846-1849.
FULL TEXT  

Baseline Risk of Major Bleeding in Non-ST-Segment-Elevation Myocardial Infarction: The CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Bleeding Score
Subherwal et al.
Circulation 2009;119:1873-1882.
ABSTRACT | FULL TEXT  

Temporal management patterns and outcomes of non-ST elevation acute coronary syndromes in patients with kidney dysfunction
Wong et al.
Eur Heart J 2009;30:549-557.
ABSTRACT | FULL TEXT  

Treatment disparities in patients with acute coronary syndromes and kidney disease
McCullough
Eur Heart J 2009;30:526-527.
FULL TEXT  

Understanding Physicians' Risk Stratification of Acute Coronary Syndromes: Insights From the Canadian ACS 2 Registry
Yan et al.
Arch Intern Med 2009;169:372-378.
ABSTRACT | FULL TEXT  

Association of Elevated Fasting Glucose With Increased Short-term and 6-Month Mortality in ST-Segment Elevation and Non-ST-Segment Elevation Acute Coronary Syndromes: The Global Registry of Acute Coronary Events
Sinnaeve et al.
Arch Intern Med 2009;169:402-409.
ABSTRACT | FULL TEXT  

Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events
Steg et al.
Eur Heart J 2009;30:321-329.
ABSTRACT | FULL TEXT  

Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database
Gale et al.
Heart 2009;95:221-227.
ABSTRACT | FULL TEXT  

Evaluating risks and benefits in coronary revascularisation--a very imperfect art?
de Belder and Hamilton
Heart 2009;95:6-8.
FULL TEXT  

Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events
Dey et al.
Heart 2009;95:20-26.
ABSTRACT | FULL TEXT  

Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database
Gale et al.
Heart 2008;94:1407-1412.
ABSTRACT | FULL TEXT  

Type-D Personality and Cortisol in Survivors of Acute Coronary Syndrome
Molloy et al.
Psychosom. Med. 2008;70:863-868.
ABSTRACT | FULL TEXT  

A Plethora of Prognostic Pearls
Alpert
Circulation 2008;118:1312-1313.
FULL TEXT  

Persistence of Posttraumatic Stress Symptoms 12 and 36 Months After Acute Coronary Syndrome
Wikman et al.
Psychosom. Med. 2008;70:764-772.
ABSTRACT | FULL TEXT  

Prevalence, Predictors, and Impact of Conservative Medical Management for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Who Have Angiographically Documented Significant Coronary Disease
Chan et al.
J Am Coll Cardiol Intv 2008;1:369-378.
ABSTRACT | FULL TEXT  

Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: The Global Registry of Acute Coronary Events
Devlin et al.
Eur Heart J 2008;29:1275-1282.
ABSTRACT | FULL TEXT  

Development and Validation of an All-Cause Mortality Risk Score in Type 2 Diabetes: The Hong Kong Diabetes Registry
Yang et al.
Arch Intern Med 2008;168:451-457.
ABSTRACT | FULL TEXT  

Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go
Eagle et al.
Eur Heart J 2008;29:609-617.
ABSTRACT | FULL TEXT  

Outcomes with the use of glycoprotein IIb/IIIa inhibitors in non-ST-segment elevation acute coronary syndromes
Dabbous et al.
Heart 2008;94:159-165.
ABSTRACT | FULL TEXT  

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention
American College of Cardiology/American Heart Asso et al.
J Am Coll Cardiol 2008;51:172-209.
FULL TEXT  

2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee
King et al.
Circulation 2008;117:261-295.
FULL TEXT  

Predictors of Outcome and the Lack of Effect of Percutaneous Coronary Intervention Across the Risk Strata in Patients With Persistent Total Occlusion After Myocardial Infarction. Results From the Occluded Artery Trial (OAT).
Kruk et al.
J Am Coll Cardiol Intv 2008;1:511-520.
ABSTRACT | FULL TEXT  

Does Comorbidity Account for the Excess Mortality in Patients With Major Bleeding in Acute Myocardial Infarction?
Spencer et al.
Circulation 2007;116:2793-2801.
ABSTRACT | FULL TEXT  

Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events
Nallamothu et al.
Heart 2007;93:1552-1555.
ABSTRACT | FULL TEXT  

Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values
Kilcullen et al.
J Am Coll Cardiol 2007;50:2061-2067.
ABSTRACT | FULL TEXT  

Acute Noncardiac Conditions and In-Hospital Mortality in Patients With Acute Myocardial Infarction
Lichtman et al.
Circulation 2007;116:1925-1930.
ABSTRACT | FULL TEXT  

Lower Rates of Heart Failure and Death in Acute Coronary Syndromes
Fedeli et al.
JAMA 2007;298:970-970.
FULL TEXT  

Influence of Renal Function on the Efficacy and Safety of Fondaparinux Relative to Enoxaparin in Non-ST-Segment Elevation Acute Coronary Syndromes
Fox et al.
ANN INTERN MED 2007;147:304-310.
ABSTRACT | FULL TEXT  

Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women
Westerhout et al.
Eur Heart J 2007;28:2064-2069.
ABSTRACT | FULL TEXT  

Resting Heart Rate in Cardiovascular Disease
Fox et al.
J Am Coll Cardiol 2007;50:823-830.
ABSTRACT | FULL TEXT  

Diabetes and Mortality Following Acute Coronary Syndromes
Donahoe et al.
JAMA 2007;298:765-775.
ABSTRACT | FULL TEXT  

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Anderson et al.
J Am Coll Cardiol 2007;50:e1-e157.
FULL TEXT  

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Anderson et al.
J Am Coll Cardiol 2007;50:652-726.
FULL TEXT  

Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent?
Nguyen et al.
Eur Heart J 2007;28:1717-1722.
ABSTRACT | FULL TEXT  

Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Authors/Task Force Members et al.
Eur Heart J 2007;28:1598-1660.
FULL TEXT  

Acute coronary syndromes without ST segment elevation
Peters et al.
BMJ 2007;334:1265-1269.
FULL TEXT  

The Impact of Renal Dysfunction on Outcomes in the ExTRACT-TIMI 25 Trial
Fox et al.
J Am Coll Cardiol 2007;49:2249-2255.
ABSTRACT | FULL TEXT  

Acute Coronary Care in the Elderly, Part I: Non-ST-Segment-Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Alexander et al.
Circulation 2007;115:2549-2569.
ABSTRACT | FULL TEXT  

Fasting Glucose in Acute Myocardial Infarction: Incremental value for long-term mortality and relationship with left ventricular systolic function
Aronson et al.
Diabetes Care 2007;30:960-966.
ABSTRACT | FULL TEXT  

Psychological and clinical predictors of return to work after acute coronary syndrome
Bhattacharyya et al.
Eur Heart J 2007;28:160-165.
ABSTRACT | FULL TEXT  

Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction
Aronson et al.
Arch Intern Med 2006;166:2362-2368.
ABSTRACT | FULL TEXT  

Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)
Fox et al.
BMJ 2006;333:1091-1091.
ABSTRACT | FULL TEXT  

Short- and Long-Term Risk Stratification in Acute Coronary Syndromes: The Added Value of Quantitative ST-Segment Depression and Multiple Biomarkers
Westerhout et al.
J Am Coll Cardiol 2006;48:939-947.
ABSTRACT | FULL TEXT  

Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation
Collinson et al.
QJM 2006;99:601-607.
ABSTRACT | FULL TEXT  

Post-traumatic stress disorder in patients with cardiac disease: predicting vulnerability from emotional responses during admission for acute coronary syndromes
Whitehead et al.
Heart 2006;92:1225-1229.
ABSTRACT | FULL TEXT  

Triggering of acute coronary syndromes by physical exertion and anger: clinical and sociodemographic characteristics
Strike et al.
Heart 2006;92:1035-1040.
ABSTRACT | FULL TEXT  

Validity of the GRACE (Global Registry of Acute Coronary Events) acute coronary syndrome prediction model for six month post-discharge death in an independent data set
Bradshaw et al.
Heart 2006;92:905-909.
ABSTRACT | FULL TEXT  

The impact of morbid events on survival following hospitalization for complicated myocardial infarction
Dickstein et al.
Eur J Heart Fail 2006;8:74-80.
ABSTRACT | FULL TEXT  

Part 5: Acute Coronary Syndromes
Circulation 2005;112:III-55-III-72.
FULL TEXT  

Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events
Collet et al.
Eur Heart J 2005;26:2285-2293.
ABSTRACT | FULL TEXT  

Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients
Clayton et al.
BMJ 2005;331:869.
ABSTRACT | FULL TEXT  

Circulating Secretory Phospholipase A2 Activity Predicts Recurrent Events in Patients With Severe Acute Coronary Syndromes
Mallat et al.
J Am Coll Cardiol 2005;46:1249-1257.
ABSTRACT | FULL TEXT  

The Year in Non--ST-Segment Elevation Acute Coronary Syndromes
Giugliano and Braunwald
J Am Coll Cardiol 2005;46:906-919.
FULL TEXT  

The declining prevalence of ST elevation myocardial infarction in patients presenting with acute coronary syndromes
Kleiman and White
Heart 2005;91:1121-1123.
ABSTRACT | FULL TEXT  

Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit
Rothberg et al.
ANN INTERN MED 2005;143:241-250.
ABSTRACT | FULL TEXT  

Magnitude of and Risk Factors for In-Hospital and Postdischarge Stroke in Patients With Acute Coronary Syndromes: Findings From a Global Registry of Acute Coronary Events
Budaj et al.
Circulation 2005;111:3242-3247.
ABSTRACT | FULL TEXT  

Impact of combined pharmacologic treatment with clopidogrel and a statin on outcomes of patients with non-ST-segment elevation acute coronary syndromes: perspectives from a large multinational registry
Lim et al.
Eur Heart J 2005;26:1063-1069.
ABSTRACT | FULL TEXT  

Compliance with guidelines and 1-year mortality in patients with acute myocardial infarction: a prospective study
Schiele et al.
Eur Heart J 2005;26:873-880.
ABSTRACT | FULL TEXT  

TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS
de Araujo Goncalves et al.
Eur Heart J 2005;26:865-872.
ABSTRACT | FULL TEXT  

Value of community-derived risk models for stratifying patients with non-ST elevation acute coronary syndromes
Wong and White
Eur Heart J 2005;26:851-852.
FULL TEXT  

Optimizing the Prediction of Perioperative Mortality in Vascular Surgery by Using a Customized Probability Model
Kertai et al.
Arch Intern Med 2005;165:898-904.
ABSTRACT | FULL TEXT  

Access to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study
Van de Werf et al.
BMJ 2005;330:441.
ABSTRACT | FULL TEXT  

Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association
Lansky et al.
Circulation 2005;111:940-953.
ABSTRACT | FULL TEXT  

A Simplified Approach to the Management of Non-ST-Segment Elevation Acute Coronary Syndromes
Gluckman et al.
JAMA 2005;293:349-357.
ABSTRACT | FULL TEXT  

Troponin in patients with chest pain
Curzen
BMJ 2004;329:1357-1358.
FULL TEXT  

Mortality following non-ST elevation acute coronary syndrome: 4 years follow-up of the PRAIS UK Registry (Prospective Registry of Acute Ischaemic Syndromes in the UK)
Taneja et al.
Eur Heart J 2004;25:2013-2018.
ABSTRACT | FULL TEXT  

23 Apr 2004 to 23 Jul 2004
Evid. Based Nurs. 2004;7:e4-e4.
FULL TEXT  

A Simple Decision Tool to Use for ACS Patients
Journal Watch Cardiology 2004;2004:3-3.
FULL TEXT  

Cardiovascular News
SoRelle
Circulation 2004;109:e9050-e9051.
FULL TEXT