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

J 2025

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

WENZL, Florian A; Klaus F KOFOED; Moa SIMONSSON; Gareth AMBLER; Niels M R van der SANGEN et al.

Základní údaje

Originální název

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

Autoři

Vydání

Lancet Digital Health, AMSTERDAM, ELSEVIER, 2025, 2589-7500

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Nizozemské království

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 24.100 v roce 2024

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/25:00142762

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

Non-ST-elevation acute coronary syndrome; GRACE score; risk stratification; prognostic model; international validation

Štítky

14110211, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 2. 2. 2026 14:58, Mgr. Eva Suchánková

Anotace

V originále

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; pinteraction=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’s long-term cardiovascular benefit from early invasive management could refine future trial design.

Návaznosti

MUNI/A/1788/2024, interní kód MU

Název: Výzkum biomarkerů u akutních kardiovaskulárních onemocnění

Investor: Masarykova univerzita, Výzkum biomarkerů u akutních kardiovaskulárních onemocnění

Citovat

WENZL, Florian A; Klaus F KOFOED; Moa SIMONSSON; Gareth AMBLER; Niels M R van der SANGEN; Erik LAMPA; Francesco BRUNO; Mark A de BELDER; Jiří HLÁSENSKÝ; Matthias MUELLER-HENNESSEN; Maria A SMOLLE; Peizhi WANG; José 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 RADOVANOVIC; Jiří PAŘENICA; Charalambos A ANTONIADES; Keith A A FOX; Fabrizio D'ASCENZO; Jurriën M Ten BERG; Lars V KØBER; Stefan JAMES; John DEANFIELD a Thomas F LÜSCHER. Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries. Lancet Digital Health. AMSTERDAM: ELSEVIER, 2025, roč. 7, č. 10, s. 1-14. ISSN 2589-7500. Dostupné z: https://doi.org/10.1016/j.landig.2025.100907.

@article{2536938,
   author = {Wenzl, Florian A and Kofoed, Klaus F and Simonsson, Moa and Ambler, Gareth and Sangen, Niels M R van der and Lampa, Erik and Bruno, Francesco and Belder, Mark A de and Hlásenský, Jiří and MuellerandHennessen, Matthias and Smolle, Maria A and Wang, Peizhi and Henriques, José P S and Kikkert, Wouter J and Kelbæk, Henning and Bouček, Luboš and RaposeirasandRoubín, Sergio and AbuandAssi, Emad and Azzahhafi, Jaouad and Velders, Matthijs A and Stellos, Konstantinos and Engstrøm, Thomas and Yin, Dean R P P Chan Pin and Weston, Clive and Adlam, David and Rickli, Hans and Giannitsis, Evangelos and Radovanovic, Dragana and Pařenica, Jiří and Antoniades, Charalambos A and Fox, Keith A A and D'Ascenzo, Fabrizio and Berg, Jurriën M Ten and Køber, Lars V and James, Stefan and Deanfield, John and Lüscher, Thomas F},
   article_location = {AMSTERDAM},
   article_number = {10},
   doi = {https://doi.org/10.1016/j.landig.2025.100907},
   keywords = {Non-ST-elevation acute coronary syndrome; GRACE score; risk stratification; prognostic model; international validation},
   language = {eng},
   issn = {2589-7500},
   journal = {Lancet Digital Health},
   title = {Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries},
   url = {https://www.thelancet.com/journals/landig/article/PIIS2589-7500(25)00089-5/fulltext},
   volume = {7},
   year = {2025}
}

TY  - JOUR
ID  - 2536938
AU  - Wenzl, Florian A - Kofoed, Klaus F - Simonsson, Moa - Ambler, Gareth - Sangen, Niels M R van der - Lampa, Erik - Bruno, Francesco - Belder, Mark A de - Hlásenský, Jiří - Mueller-Hennessen, Matthias - Smolle, Maria A - Wang, Peizhi - Henriques, José P S - Kikkert, Wouter J - Kelbæk, Henning - Bouček, Luboš - Raposeiras-Roubín, Sergio - Abu-Assi, Emad - Azzahhafi, Jaouad - Velders, Matthijs A - Stellos, Konstantinos - Engstrøm, Thomas - Yin, Dean R P P Chan Pin - Weston, Clive - Adlam, David - Rickli, Hans - Giannitsis, Evangelos - Radovanovic, Dragana - Pařenica, Jiří - Antoniades, Charalambos A - Fox, Keith A A - D'Ascenzo, Fabrizio - Berg, Jurriën M Ten - Køber, Lars V - James, Stefan - Deanfield, John - Lüscher, Thomas F
PY  - 2025
TI  - Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries
JF  - Lancet Digital Health
VL  - 7
IS  - 10
SP  - 1-14
EP  - 1-14
PB  - ELSEVIER
SN  - 25897500
KW  - Non-ST-elevation acute coronary syndrome
KW  - GRACE score
KW  - risk stratification
KW  - prognostic model
KW  - international validation
UR  - https://www.thelancet.com/journals/landig/article/PIIS2589-7500(25)00089-5/fulltext
N2  - 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; pinteraction=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’s long-term cardiovascular benefit from early invasive management could refine future trial design.
ER  -

WENZL, Florian A; Klaus F KOFOED; Moa SIMONSSON; Gareth AMBLER; Niels M R van der SANGEN; Erik LAMPA; Francesco BRUNO; Mark A de BELDER; Jiří HLÁSENSKÝ; Matthias MUELLER-HENNESSEN; Maria A SMOLLE; Peizhi WANG; José 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 RADOVANOVIC; Jiří PAŘENICA; Charalambos A ANTONIADES; Keith A A FOX; Fabrizio D'ASCENZO; Jurri$\backslash$''en M Ten BERG; Lars V KØBER; Stefan JAMES; John DEANFIELD a Thomas F LÜSCHER. Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries. \textit{Lancet Digital Health}. AMSTERDAM: ELSEVIER, 2025, roč.~7, č.~10, s.~1-14. ISSN~2589-7500. Dostupné z: https://doi.org/10.1016/j.landig.2025.100907.

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