GRACE

ACS RISK SCORE

University of Edinburgh

ACS RISK SCORE

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ACS RISK SCORE

Validation

Validation

The score has been both internally and externally validated. Internal validation was demonstrated in a prospective dataset2 and external validation in an independent population of patients with ACS4. The National Institute for Clinical Excellence (NICE) tested all of the published risk scores for acute coronary syndrome using an unselected population of approximately 70,000 patients from the United Kingdom, MINAP programme (Myocardial Infarction National Audit Project)5. The NICE Guideline 94 (and other major guidelines6,7) then recommended that a risk scoring system is required in ACS and that the GRACE risk score should be used because of its superior performance when compared with all the other published risk scoring tools.5

Independent external validation

Independent external validation has been completed in many different healthcare settings and different geographic locations. Examples include a validation study in Brazil which demonstrated superiority of the GRACE score compared to the TIMI risk score.8 Similarly in Portugal, investigators compared the TIMI, PURSUIT and GRACE risk scores, showing superior performance for the GRACE score.9 In China, Khalill and colleagues performed an extensive analysis of all the published literature from PubMed and other databases (1996-2008) and evaluated all the published risk scores. They conclude the GRACE score was “superior to the others and easier to use.10 Similarly, the risk score was validated in Spain using a contemporary cohort of patients admitted to Spanish hospitals11 and similarly in Egypt.12 Investigators from New Zealand tested the GRACE risk score in a long term study over 4 years and demonstrated good accuracy and a C index of 0.80, sustained throughout the 4 years and with robust goodness of fit.13