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

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F65269705%3A_____%2F25%3A00082822" target="_blank" >RIV/65269705:_____/25:00082822 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216224:14110/25:00142762

Výsledek na webu

<a href="https://www.sciencedirect.com/science/article/pii/S2589750025000895" target="_blank" >https://www.sciencedirect.com/science/article/pii/S2589750025000895</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.landig.2025.100907" target="_blank" >10.1016/j.landig.2025.100907</a>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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 mortality model (time-dependent AUC 0.84, 95% CI 0.82-0.86) showed excellent discriminative abilities on external validation across all countries. Both models were well calibrated and decision curve analyses suggested favourable clinical utility. Compared with score version 2.0, both models provided improved discrimination and risk reclassification. The individualised treatment effect model effectively identified patients who would benefit from early invasive management on external validation. Patients with high predicted benefit had reduced risk of the composite outcome when randomly assigned to early invasive management (hazard ratio 0.60, 95% CI 0.41-0.88), whereas patients with no-to-moderate predicted benefit did not (1.06, 0.80-1.40; p(interaction)=0.014). The individualised treatment effect model suggested that the group of patients with NSTE-ACS who benefit from early intervention might be incompletely captured by current treatment strategies. INTERPRETATION: The updated GRACE 3.0 scoring system provides a validated, practical tool to support personalised risk assessment in patients with NSTE-ACS. Prediction of an individual&apos;s long-term cardiovascular benefit from early invasive management could refine future trial design. FUNDING: Swiss Heart Foundation, University of Zurich Foundation, Kurt and Senta Herrmann Foundation, Theodor and Ida Herzog-Egli Foundation, and Foundation for Cardiovascular Research-Zurich Heart House.

Název v anglickém jazyce

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

Popis výsledku anglicky

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 mortality model (time-dependent AUC 0.84, 95% CI 0.82-0.86) showed excellent discriminative abilities on external validation across all countries. Both models were well calibrated and decision curve analyses suggested favourable clinical utility. Compared with score version 2.0, both models provided improved discrimination and risk reclassification. The individualised treatment effect model effectively identified patients who would benefit from early invasive management on external validation. Patients with high predicted benefit had reduced risk of the composite outcome when randomly assigned to early invasive management (hazard ratio 0.60, 95% CI 0.41-0.88), whereas patients with no-to-moderate predicted benefit did not (1.06, 0.80-1.40; p(interaction)=0.014). The individualised treatment effect model suggested that the group of patients with NSTE-ACS who benefit from early intervention might be incompletely captured by current treatment strategies. INTERPRETATION: The updated GRACE 3.0 scoring system provides a validated, practical tool to support personalised risk assessment in patients with NSTE-ACS. Prediction of an individual&apos;s long-term cardiovascular benefit from early invasive management could refine future trial design. FUNDING: Swiss Heart Foundation, University of Zurich Foundation, Kurt and Senta Herrmann Foundation, Theodor and Ida Herzog-Egli Foundation, and Foundation for Cardiovascular Research-Zurich Heart House.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30218 - General and internal medicine

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Lancet Digital Health

ISSN

2589-7500

e-ISSN

2589-7500

Svazek periodika

7

Číslo periodika v rámci svazku

10

Stát vydavatele periodika

NL - Nizozemsko

Počet stran výsledku

14

Strana od-do

100907

Kód UT WoS článku

001637447500003

EID výsledku v databázi Scopus

2-s2.0-105024018724