Moledina, SM, Kontopantelis, E, Wijeysundera, HC, Banerjee, S, Van Spall, HGC, Gale, CP, Shah, BN, Mohamed, MO, Weston, C, Shoaib, A and Mamas, MA (2022) Ethnicity-dependent performance of the GRACE risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: Nationwide cohort study. European Heart Journal. ISSN 0195-668X (In Press)

[thumbnail of GRACE ETHNICITY FINAL SMM_jan4th_PL.docx] Text
GRACE ETHNICITY FINAL SMM_jan4th_PL.docx - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (102kB)
[thumbnail of GRACE fig_SM.docx] Text
GRACE fig_SM.docx - Supplemental Material
Available under License Creative Commons Attribution Non-commercial.

Download (9MB)
[thumbnail of Figure_v2-01.tif]
Figure_v2-01.tif - Supplemental Material
Available under License Creative Commons Attribution Non-commercial.

Download (8MB) | Preview


Background: The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with acute coronary syndrome with or without ST-segment elevation. Little is known about its performance at predicting in-hospital mortality for ethnic minority patients. Methods and Results: We identified 326,160 admissions with non-ST-segment elevation myocardial infarction (NSTEMI) in the Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White (n = 299,184) and ethnic minorities (excluding White minorities) (n=26,976). We calculated the GRACE score for in-hospital mortality and assessed ethnic group baseline characteristics by low, intermediate and high risk. Performance of the GRACE risk score was estimated by discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plots). Ethnic minorities presented younger and had increased prevalence of cardiometabolic risk factors in all GRACE risk groups. The GRACE risk score for White (AUC 0.87, 95% confidence interval [CI] 0.86-0.87) and ethnic minority (AUC 0.87, 95% CI 0.86-0.88) patients had good discrimination. However, whilst the GRACE risk model was well calibrated in White patients (expected to observed (E:O) in-hospital death rate ratio 0.99; slope 1.00), it overestimated risk in ethnic minority patients (E:O ratio 1.29; slope: 0.94). Conclusion: The GRACE risk score provided good discrimination overall for in-hospital mortality, but was not well calibrated and overestimated risk for ethnic minorities with NSTEMI.

Item Type: Article
Additional Information: © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (
Uncontrolled Keywords: NSTEMI; Ethnicity; GRACE; Risk
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 08 Feb 2022 12:41
Last Modified: 24 Feb 2023 01:30

Actions (login required)

View Item
View Item