Abstract 17853: Efficacy of Grace Score for Prediction of Mortality in Patients of Acute Coronary Syndrome: A Meta-Analysis

Abstract

Introduction: The Global Registry of Acute Coronary Syndrome (GRACE) is a validated risk prediction model for acute coronary syndromes (ACS). However, discrimination ability of this model for predicting mortality in ACS remains unclear. The aim of this meta-analysis is to determine the predictive accuracy of GRACE score for mortality in ACS patients. Methods: A comprehensive literature search was conducted across MEDLINE, Embase & the Cochrane Library from inception till May 2023. All studies that reported the C-statistic for predicting in-hospital, 6-month, 1 year & 2-year mortality in ACS patients were included. The generic inverse variance weighted random effects method was used to pool C-statistics & corresponding standard errors (SEs) from each study. Subgroup analysis was conducted based on whether the patients required percutaneous coronary intervention (PCI) or not. Results: A total of 22 studies with a patient population of 132856 were included. For in-hospital mortality (n=99774), the GRACE score showed a good discrimination ability to predict mortality (summary C-statistic 0.86 [0.85-0.87], I 2 =58%). The pooled C-statistic for 6-month mortality (n=24174) was 0.80 (0.70-0.84; I 2 =93%). For 1-year mortality (n=13517), the predictive accuracy of the GRACE score was moderate (summary estimate= 0.77 [0.70-0.83]; I 2 =94%). The GRACE score proved to be moderately accurate in predicting 2-year mortality (n=4972) in ACS patients [0.75 (0.66-0.83); I 2 =66%]. All the findings were consistent across the two subgroups of PCI vs no PCI (p for interaction >0.05). Conclusion: The GRACE score is a simple scoring system that demonstrated good predictive ability for in hospital mortality, & at 6-months while moderate predictive ability for the risk of death at 1-year, & 2-year in patients of ACS with & without PCI.