Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries

作者：Florian A. Wenzl, Klaus F. Kofoed, Moa Simonsson, Gareth Ambler, Niels M R van der Sangen, Erik Lampa, Francesco Bruno, Mark de Belder, Jiří Hlásenský, Matthias Mueller‐Hennessen, Maria Anna Smolle, Peizhi Wang, Josè P.S. Henriques, Wouter J. Kikkert, Henning Kelbæk, Luboš Bouček, Sergio Raposeiras‐Roubín, Emad Abu-Assi, Jaouad Azzahhafi, Matthijs A. Velders, Konstantinos Stellos, Thomas Engstrøm, Dean R.P.P. Chan Pin Yin, Clive Weston, David Adlam, Hans Rickli, Evangelos Giannitsis, Dragana Radovanović, Jiří Pařenica, Charalambos Antoniades, Keith A.A. Fox, Fabrizio D'Ascenzo, Jurriën M. ten Berg, Lars Køber, Stefan James, John Deanfield, T F Luescher · 发表于：The Lancet Digital Health · 年份：2025 · DOI：10.1016/j.landig.2025.100907 · 被引用次数：10 · 研究领域：Acute Myocardial Infarction Research、Coronary Interventions and Diagnostics、Sepsis Diagnosis and Treatment

Background The Global Registry of Acute Coronary Events (GRACE) scoring system guides the management of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) according to current guidelines. However, broad validation of the sex-specific GRACE 3.0 in-hospital mortality model, and corresponding models for predicting long-term mortality and the personalised effect of early invasive management, are still needed. Methods We used data of 609 063 patients with NSTE-ACS from ten countries between Jan 1, 2005, and June 24, 2024. A machine learning model for 1-year mortality was developed in 400 054 patients from England, Wales, and Northern Ireland. Both the in-hospital mortality model and the new 1-year mortality model were externally validated in patients from Sweden, Switzerland, Germany, Denmark, Spain, the Netherlands, and Czechia. A separate machine learning model to predict the individualised effect of early versus delayed invasive coronary angiography and revascularisation on a composite primary outcome of all-cause death, non-fatal recurrent myocardial infarction, hospital admission for refractory myocardial ischaemia, or hospital admission for heart failure at a median follow-up of 4·3 years was developed and externally validated in participants from geographically different sets of hospitals in the Danish VERDICT trial. Findings The in-hospital mortality model (area under the receiver operating characteristic curve [AUC] 0·90, 95% CI 0·89–0·91) and the 1-year mo...