Document Detail


Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003-2009: National Institute for Cardiovascular Outcomes Research (NICOR).
MedLine Citation:
PMID:  23002253     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the performance of the National Institute for Health and Clinical Excellence (NICE) mini-Global Registry of Acute Coronary Events (GRACE) (MG) and adjusted mini-GRACE (AMG) risk scores.
DESIGN: Retrospective observational study.
SETTING: 215 acute hospitals in England and Wales.
PATIENTS: 137 084 patients discharged from hospital with a diagnosis of acute myocardial infarction (AMI) between 2003 and 2009, as recorded in the Myocardial Ischaemia National Audit Project (MINAP).
MAIN OUTCOME MEASURES: Model performance indices of calibration accuracy, discriminative and explanatory performance, including net reclassification index (NRI) and integrated discrimination improvement.
RESULTS: Of 495 263 index patients hospitalised with AMI, there were 53 196 ST elevation myocardial infarction and 83 888 non-ST elevation myocardial infarction (NSTEMI) (27.7%) cases with complete data for all AMG variables. For AMI, AMG calibration was better than MG calibration (Hosmer-Lemeshow goodness of fit test: p=0.33 vs p<0.05). MG and AMG predictive accuracy and discriminative ability were good (Brier score: 0.10 vs 0.09; C statistic: 0.82 and 0.84, respectively). The NRI of AMG over MG was 8.1% (p<0.05). Model performance was reduced in patients with NSTEMI, chronic heart failure, chronic renal failure and in patients aged ≥85 years.
CONCLUSIONS: The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors.
Authors:
Alexander D Simms; Stephanie Reynolds; Karen Pieper; Paul D Baxter; Brian A Cattle; Phillip D Batin; John I Wilson; John E Deanfield; Robert M West; Keith A A Fox; Alistair S Hall; Christopher P Gale
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2012-09-22
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  99     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-19     Completed Date:  2013-02-14     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Academies and Institutes*
Aged
England / epidemiology
Female
Humans
Male
Medical Audit
Myocardial Infarction / classification,  diagnosis*,  mortality
Outcome Assessment (Health Care) / methods*
Prognosis
Registries
Reproducibility of Results
Retrospective Studies
Risk Assessment*
Risk Factors
Severity of Illness Index
Survival Rate
Time Factors
Wales / epidemiology
Grant Support
ID/Acronym/Agency:
MR/K006584/1//Medical Research Council; PG/07/057/23215//British Heart Foundation

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