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To the Editor: Dr Fox and colleagues¹ reported decreasing rates of death after hospitalization for ACS in the GRACE registry. They showed that crude in-hospital mortality for non–ST-segment elevation ACS remained unchanged over time, whereas a decline was seen when risk-adjusted rates were analyzed; this difference is due to a 5-point increase in the mean in-hospital risk score. The patients' characteristic with the largest change from 1999 to 2005 was the percentage of patients with positive initial enzyme levels (+17%). According to the method of risk quantification used in this study,² the14 points assigned to elevated enzyme levels in the risk score suggests that this could explain nearly half of the mean change in risk score (14x0.17 = 2.4). Therefore, the increased use of troponin measurement may have significantly influenced the risk-adjusted comparisons between study periods.

In addition, all outcomes are reported separately for the hospitalization and for 6-month follow-up, . . . [Full Text of this Article]

Ugo Fedeli, MD
ugo.fedeli@ulssasolo.ven.it

Stefano Brocco, MD; Paolo Spolaore, MD
SER-Epidemiological Department, Veneto Region
Castelfranco Veneto (TV), Italy

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