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Validation of two US risk scores for percutaneous coronary intervention in a single-center Portuguese population of patients with acute coronary syndrome

Timóteo, A. ; Monteiro, A. ; Portugal, G. ; Teixeira, P. ; Aidos, H. ; Ferreira, M. ; Ferreira, R.

Revista Portuguesa de Cardiologia Vol. 35, Nº 2, pp. 73 - 78, February, 2016.

ISSN (print): 2174-2049
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New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score.


In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores.


A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91–0.96) compared with NCDR (0.87, 95% CI 0.83–0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81–0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6–97.7; IDI 0.136, 95% CI 0.073–0.199) or NCDR (NRI 79.2, 95% CI 60.2–98.2; IDI 0.148, 95% CI 0.087–0.209).