The Fourth Universal Definition of Myocardial Infarction recommends the use of high-sensitivity cardiac troponin (hs-cTn) assays and a sex-specific 99th centile diagnostic threshold for myocardial injury and infarction. Since the introduction of the GRACE score, there have been significant changes in the way we diagnose myocardial infarction, driven by major improvements in the sensitivity of cardiac troponin. The use of the GRACE 2.0 score in patients with non-ST-segment elevation acute coronary syndrome has a class Ia recommendation for guiding prognosis and IIa recommendation for guiding management across all international guidelines. 2–5 The score applies clinical variables, the electrocardiogram, and cardiac biomarkers to estimate risk of future all-cause mortality and myocardial infarction. 1 To improve prognostication and promote consistency in the investigation and management of patients with acute coronary syndrome, the Global Registry of Acute Coronary Events (GRACE) score was developed. See page 2562 for the editorial comment on this article (doi: 10.1093/eurheartj/ehaa486) IntroductionĬoronary heart disease is responsible for around 2 million deaths across Europe every year. Type 1 myocardial infarction, Type 2 myocardial infarction, Universal definition, GRACE, High-sensitivity, Troponin The AUC was 0.73 (95% CI 0.70–0.77) and 0.73 (95% CI 0.66–0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts ( P < 0.001 and P = 0.008, respectively). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong’s test. In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland ( n = 48 282) and a tertiary care hospital in Sweden ( n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year.
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