Validation of the GRACE Risk Score to Predict in-Hospital Mortality in Patients with ST Segment Elevation Myocardial Infarction in Thailand
Ekkhalak Koonsiripaiboon MD*, Wiwun Tungsubutra MD*
Affiliation : * Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The GRACE risk score (GRS) is a validated risk score to predict mortality in acute coronary syndrome
patients. However, data on the use of the GRS in Asian patients are limited. The authors assessed the validity of this risk score
in a contemporary cohort of patients with ST segment elevation myocardial infarction (STEMI) admitted to a tertiary care
hospital in Thailand.
Material and Method: From June 1, 2008 through May 31, 2010, 209 consecutive patients with STEMI were prospectively
enrolled. The GRS was calculated for each patient. Patients were stratified into three GRACE risk tertiles: high, intermediate
and low risk groups. In-hospital mortality rate was assessed and compared to the GRS predicted mortality.
Results : The mean GRS was 161 + 46.2 and the overall in-hospital mortality was 12.4%. Using the GRS, 103 (49.3%)
patients were stratified to the high-risk group (> 155 points), 59 (28.2%) patients to the intermediate-risk group (126-154
points) and 47 (22.5%) patients to the low-risk group (< 125 points). The observed in-hospital mortality rate was 23.3%
(95% CI 16.2-32.3) in the high-risk group and 3.4% (95% CI 0.94-11.5) in the intermediate-risk group. None of the patients
in the low risk group died, 0% (95% CI 0-7.9) (p < 0.001, low risk vs. high risk; p = 0.001 intermediate risk vs. high risk)
Conclusion : Use of the GRS in STEMI patients for predicting in-hospital mortality was validated. At the author’s institute, the
GRS is a useful tool to predict in-hospital death in STEMI patients.
Keywords : Acute coronary syndrome, ST-segment elevation myocardial infarction, GRACE, Risk stratification
