Risk stratification for the development of heart failure after acute coronary syndrome at the time of hospital discharge: Predictive ability of GRACE risk score

Abstract

BackgroundDespite encouraging declines in the incidence of heart failure (HF) complicating acute coronary syndrome (ACS), it remains a common problem with high mortality. Being able to identify patients at high risk of HF after ACS would have great clinical and economic impact. With this study, we assessed the usefulness of the GRACE score to predict HF after an ACS. MethodsWe studied 4137 consecutive patients discharged with diagnosis of ACS. We analyzed HF incidence, timing, and association with the follow-up mortality. Cox proportional hazards modeling was performed to assess the accuracy of the GRACE risk score to predict HF admissions in follow-up (median 3.1 years). ResultsA total of 433 patients (10.5%) developed HF. GRACE score was an independent predictor of HF after ACS [hazard ratio (HR) 1.02, 95% confidence interval (CI): 1.01–1.03, p<0.001]. A risk gradient for the development of HF with GRACE risk score was shown: high- and moderate-GRACE risk groups have been linked to a sixfold and twofold increased risk of HF. This risk gradient was maintained in patients with and without prior history of HF, in ST elevation myocardial infarction and non-ST elevation myocardial infarction groups, and in patients with depressed and preserved left ventricular ejection fraction. The development of HF was associated with high mortality (54.5% vs 13.4%; HR=4.48; 95% CI: 3.84–5.24; p<0.001). After adjusting for GRACE risk score, HF development resulted as an independent predictor of mortality. ConclusionGRACE risk score has been shown to provide clinically relevant stratification of follow-up HF admission risk at the time of hospital discharge in patients with ACS.