Eagle et al reported the prediction model from Global Registry of Acute Coronary Events (GRACE). This can be used to predict mortality in a patient with acute coronary syndrome (ACS) within the following 6 months. The author are from multiple hospitals across North America and Europe.
The acute coronary syndrome (ACS) includes:
(1) ST-segment elevation myocardial infarction
(2) non-ST segment elevation myocardial infarction
(3) unstable angina
Parameters:
(1) age in years
(2) history of congestive heart failure
(3) history of myocardial infarction
(4) resting heart rate on admission
(5) systolic blood pressure on admission
(6) ST segment depression on admission
(7) initial serum creatinine
(8) serum cardiac enzymes during the hospitalization
(9) in-house percutaneous coronary intervention (PCI)
|
Parameter |
Finding |
Points |
|---|---|---|
|
age in years |
<= 39 |
0 |
|
|
40 - 49 |
18 |
|
|
50 - 59 |
36 |
|
|
60 - 69 |
55 |
|
|
70 - 79 |
73 |
|
|
80 - 89 |
91 |
|
|
>= 90 |
100 |
|
history of congestive heart failure |
no |
0 |
|
|
yes |
24 |
|
history of MI |
no |
0 |
|
|
yes |
12 |
|
resting heart rate |
<= 49.9 beats per minute |
0 |
|
|
50 - 69.9 |
3 |
|
|
70 - 89.9 |
9 |
|
|
90 - 109.9 |
14 |
|
|
110 - 149.9 |
23 |
|
|
150 - 199.9 |
35 |
|
|
>= 200 |
43 |
|
systolic blood pressure |
<= 79.9 mm Hg |
24 |
|
|
80 - 99.9 |
22 |
|
|
100 - 119.9 |
18 |
|
|
120 - 139.9 |
14 |
|
|
140 - 159.9 |
10 |
|
|
160 - 199.9 |
4 |
|
|
>= 200 |
0 |
|
ST segment depression |
no |
0 |
|
|
yes |
11 |
|
initial serum creatinine |
<= 0.39 mg/dL |
1 |
|
|
0.4 - 0.79 |
3 |
|
|
0.8 - 1.19 |
5 |
|
|
1.2 - 1.59 |
7 |
|
|
1.6 - 1.99 |
9 |
|
|
2.0 - 3.99 |
15 |
|
|
>= 4.0 |
20 |
|
cardiac enzymes |
not elevated |
0 |
|
|
elevated |
15 |
|
in hospital PCI |
none |
14 |
|
|
performed |
0 |
total score =
= SUM(points for all 9 items)
Interpretation:
• minimum score: 1
• maximum score: 263
• The higher the score, the higher the 6 month mortality.
|
Total Score |
Probability of Death Within 6 Months |
|---|---|
|
70 |
0.8% |
|
90 |
1.6% |
|
110 |
3.1% |
|
130 |
5.8% |
|
150 |
11% |
|
170 |
20% |
|
190 |
34% |
|
210 |
55% |
from plot in Figure 2
If this data is analyzed in JMP, the following formula can be approximated:
probability of 6 month mortality in percent (as a whole number) =
= (0.0000255 * ((score)^3)) - (0.00668 * ((score)^2)) + (0.63204 * (score)) - 19.5446
over the range in the table. The probabilities for scores > 210 are not specified.
Purpose: To predict the 6 month mortality for a patient with acute coronary syndrome (ACS) using the GRACE model.
Specialty: Cardiology
Objective: risk factors, severity, prognosis, stage, selection
ICD-10: I20, I21,
