Clinical Research in Cardiology

, Volume 99, Issue 10, pp 627–631

GRACE risk score as predictor of in-hospital mortality in patients with chest pain

  • Siegbert Stracke
  • Oliver Dörr
  • Martin C. Heidt
  • Dursun Gündüz
  • Christiane Neuhof
  • Mariana Parahuleva
  • Harald Tillmanns
  • Ali Erdogan
Original Paper
  • 141 Downloads

Abstract

Introduction

Chest pain and chest discomfort are common problems in the acute care setting. Life-threatening causes of chest pain must be quickly differentiated from other less serious causes. There is a need to stratify risk rapidly in patients presenting to the emergency department (ED) with chest pain. This study evaluates the relationship between the GRACE risk score (GRS) and in-hospital mortality in patients presenting to the ED with chest pain of all causes.

Methods

We conducted a prospective study of a consecutive sample of 1,014 patients with chest pain and chest discomfort presenting to the medical ED of the University Clinic in Giessen, Germany. The GRS was calculated for each patient at admission. Additionally, the reason for admission into the hospital and the diagnosis on discharge or diagnosis of death were recorded. The relative risk between the risk groups was assessed, and the functional dependency between the GRS and observed in-hospital death was analyzed.

Results

A total of 94 patients died during the stay in the hospital, 83 patients with high risk, 9 with medium risk, and 2 with low risk. The risk of in-hospital death was 24.5% for high-risk patients, 2.6% for medium-risk patients, and 0.6% for patients with low risk. The correlation between the GRS and in-hospital mortality is strongly positive (p < 0.01).

Conclusion

This study shows that the GRS accurately stratifies risk of intra-hospital mortality in patients presenting to the ED with chest pain and can guide patient triage and management.

Keywords

Chest pain GRACE risk score Risk stratification 

References

  1. 1.
    Verdon F, Herzig L, Burnand B, Bischoff T, Pécoud A, Junod M, Mühlemann N, Favrat B (2008) Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly 138(23–24):340–347PubMedGoogle Scholar
  2. 2.
    Lee TH, Goldman L (2000) Evaluation of the patient with acute chest pain. N Engl J Med 342:1187–1195CrossRefPubMedGoogle Scholar
  3. 3.
    Six AJ, Backus BE, Kelder JC (2008) Chest pain in the emergency room: value of the heart score. Neth Heart J 16:191–196CrossRefPubMedGoogle Scholar
  4. 4.
    Post F, Genth-Zotz S, Munzel T (2007) Aktueller Stellenwert einer Chest Pain Unit in Deutschland. Herz 32:435–437Google Scholar
  5. 5.
    Farkouh ME, Smars PA, Reeder GS, Zinsmeister AR, Evans RW, Meloy TD, Kopecky SL, Allen M, Allison TG, Gibbons R, Gabriel S (1998) A clinical trial of a chest-pain observation unit for patients. N Engl J Med 339:1882–1888CrossRefPubMedGoogle Scholar
  6. 6.
    Goodacre S, Dixon S (2005) Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial. Emerg Med J 22:418–422CrossRefPubMedGoogle Scholar
  7. 7.
    Newby LK, Mark DB (1998) The chest pain unit—ready for prime time? N Engl J Med 339:1930–1932CrossRefPubMedGoogle Scholar
  8. 8.
    Ng SM, Krishnaswamy P, Morissey R, Clopton P, Fitzgerald R (2001) Maisel. Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol 88:611–617CrossRefPubMedGoogle Scholar
  9. 9.
    Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, Marcassa C, Quinn T, van Weert H (2002) Task force on the management of chest pain. Eur Heart J 23:1153–1176CrossRefPubMedGoogle Scholar
  10. 10.
    Lyon R, Morris AC, Caesar D, Gray S, Gray A (2007) Chest pain presenting to the Emergency Department—to stratify risk with GRACE or TIMI? Resuscitation 74:90–93CrossRefPubMedGoogle Scholar
  11. 11.
    Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van de Werf F, Avezum A, Goodman SG, Flather M, Fox KA, for the Global Registry of Acute Coronary Events Investigators (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353CrossRefPubMedGoogle Scholar
  12. 12.
    Alter DA, Venkatesh V, Chong A (2006) Evaluating the performance of the global registry of acute coronary events risk-adjustment index across socioeconomic strata among patients discharged from the hospital after acute myocardial infarction. Am Heart J 151:323–331CrossRefPubMedGoogle Scholar
  13. 13.
    Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A, Goodman SG, Flather M, Anderson FA, Granger CB (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 333:1091–1094CrossRefPubMedGoogle Scholar
  14. 14.
    Ramsay G, Podogrodzka M, Mc Clure C, FOX KAA (2001) Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. Q J Med 100:11–18Google Scholar
  15. 15.
    Santopinto JJ, Fox KA, Goldberg RJ, Budaj A, Piñero G, Avezum A, Gulba D, Esteban J, Gore JM, Johnson J, Gurfinkel EP; GRACE Investigators (2003) creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE). Heart 89:1003–1008Google Scholar
  16. 16.
    de Araújo Gonçalves P, Ferreira J, Aguiar C, Seabra-Gomes R (2005) TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J 26:865–872Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Siegbert Stracke
    • 1
    • 2
  • Oliver Dörr
    • 1
    • 2
  • Martin C. Heidt
    • 1
    • 2
  • Dursun Gündüz
    • 1
    • 2
  • Christiane Neuhof
    • 1
    • 2
  • Mariana Parahuleva
    • 1
    • 2
  • Harald Tillmanns
    • 1
    • 2
  • Ali Erdogan
    • 1
    • 2
  1. 1.Department of AngiologyUniversity Clinic GiessenGiessenGermany
  2. 2.Department of CardiologyUniversity Clinic of GiessenGiessenGermany

Personalised recommendations