![[feed]](/style/images/feed-icon-14x14.png){kind=icon}
Tools
Tools
Preview |
PDF (Publisher's Version)
- Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
1MB |
![[thumbnail of Supplementary Data]](https://edoc.mdc-berlin.de/style/images/fileicons/application_msword.png) |
MS Word (Supplementary Data)
1MB |
| Item Type: | Article |
|---|---|
| Title: | Validation of a troponin I-adapted modified GRACE score: a cohort study |
| Creators: |
Delialis, Dimitrios, Georgiopoulos, Georgios, Chrysochou, Christina, Spray, Luke, Kraler, Simon, Nastatos, Panagiotis, Manifava, Polyxeni, Konstantaki, Christina, Athanasopoulos, Stavros, Skoumas, Yannis, Pitsavos, Christos, Giannakopoulou, Sofia-Panagiota, Mavraganis, Georgios, Sopova, Kateryna, Dimopoulou, Maria-Angeliki, Papoutsis, Dimitrios, Zacharoulis, Achilleas A., Stellos, Konstantinos  ORCID: https://orcid.org/0000-0002-0194-0825, Spyridopoulos, Ioakim, Panagiotakos, Demosthenes and Stamatelopoulos, Kimon
|
| Abstract: | OBJECTIVE: A modified Global Registry of Acute Coronary Events (modGRACE) model incorporating continuous rather than binary high-sensitivity troponin T data exceeds the performance of the original GRACE score. However, whether a similar prognostic gain can be achieved using contemporary-sensitive troponin I (cTnI) remains uncertain. METHODS: We analyzed data from 2 independent acute coronary syndrome (ACS) cohorts of consecutively recruited patients: the Freeman cohort (Newcastle, United Kingdom; n = 2991) and the Greek Study of ACS (GREECS; Greece; n = 1630). Risk stratification was performed using the original GRACE score and the modGRACE score incorporating continuous c/hs-TnI values. Model performance was assessed using Harrell’s C-index and continuous net reclassification improvement (NRI). RESULTS: In the Freeman cohort, modGRACE showed improvements in discrimination for in-hospital (Harrell’s C-index = 0.871 vs. 0.777) and 30-day mortality (0.848 vs. 0.833), with significant improvement at 1 year (0.721 vs. 0.690, all p < 0.05). Reclassification improved for in-hospital (NRI = 0.67), 30-day (NRI = 0.69), and 1-year mortality (NRI = 0.49) (all p < 0.001). In the GREECS cohort, modGRACE showed improvements in discrimination for 30-day mortality (Harrell’s C-index 0.778 vs. 0.752) and cardiovascular death at 20 years (0.682 vs. 0.653, p < 0.05 for both) and improved risk reclassification for 30-day mortality (NRI, 0.56), 20-year cardiovascular mortality (NRI = 0.85), and 20-year major adverse cardiovascular events (MACE) (NRI = 0.79) (all p < 0.001). CONCLUSION: The updated ModGRACE model, incorporating continuous c/TnI alongside re-estimated baseline predictors, demonstrated consistent improvements in risk reclassification and discrimination over the original GRACE. Ultimately, these findings support the application of quantitative troponin data across different troponin assays to improve prognostic accuracy and standardize risk assessment in clinical practice. |
| Keywords: | GRACE Score, Troponin I, Acute Coronary Syndromes, Risk Stratification |
| Source: | Hellenic Journal of Cardiology |
| ISSN: | 1109-9666 |
| Publisher: | Elsevier |
| Date: | 29 September 2026 |
| Official Publication: | https://doi.org/10.1016/j.hjc.2026.09.002 |
| PubMed: | View item in PubMed |
Repository Staff Only: item control page
