GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome

Inna Y. Gong, Shaun G. Goodman, David Brieger, Chris P. Gale, Derek P. Chew, Robert C. Welsh, Thao Huynh, J. Paul DeYoung, Carolyn Baer, Gabor T. Gyenes, Jacob A. Udell, Keith A.A. Fox, Andrew T. Yan

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8 Citations (Scopus)


Background Although there are sex differences in management and outcome of acute coronary syndromes (ACS), sex is not a component of Global Registry of Acute Coronary Events (GRACE) risk score (RS) for in-hospital mortality prediction. We sought to determine the prognostic utility of GRACE RS in men and women, and whether its predictive accuracy would be augmented through sex-based modification of its components. Methods Canadian men and women enrolled in GRACE and Canadian Registry of Acute Coronary Events were stratified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS). GRACE RS was calculated as per original model. Discrimination and calibration were evaluated using the c-statistic and Hosmer-Lemeshow goodness-of-fit test, respectively. Multivariable logistic regression was undertaken to assess potential interactions of sex with GRACE RS components. Results For the overall cohort (n = 14,422), unadjusted in-hospital mortality rate was higher in women than men (4.5% vs. 3.0%, p  0.80), discrimination was lower for women compared to men with STEMI [0.80 (0.75–0.84) vs. 0.86 (0.82–0.89), respectively, p  0.25). Conclusions The GRACE RS is a valid predictor of in-hospital mortality for both men and women with ACS. The lack of interaction between sex and RS components suggests that sex-based modification is not required.
Original languageEnglish
Pages (from-to)24-29
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - 1 Oct 2017


  • Acute coronary syndrome
  • GRACE risk score
  • Risk stratification
  • Sex differences
  • Validation

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