Authors Kieran J Rothnie1, Liam Smeeth1, Emily Herrett1, Neil Pearce1, Harry Hemingway2

Title GRACE scores in COPD patients with acute coronary syndromes: performance and impact on secondary prevention

Authors Kieran J Rothnie1, Liam Smeeth1, Emily Herrett1, Neil Pearce1, Harry Hemingway2, Jadwiga Wedzicha3, Adam Timmis4, Jennifer K Quint1

Author affiliations

1. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine

2. Department of Epidemiology and Public Health, University College London

3. National Heart and Lung Institute, Imperial College London

4. Barts NIHR Biomedical Research Unit, Queen Mary University of London

Conflict of interest statement None

Allowed 1810 characters including spaces and title

Currently 1804 GRACE scores in COPD patients with acute coronary syndromes: performance and impact on secondary prevention

Background

Treatment after acute coronary syndrome (ACS) is influenced by the GRACE score which predicts the risk of death at 6 months. We investigated how well the GRACE score performed in COPD patients and how it was used to guide treatment compared to non-COPD patients.

Methods

Patients with an admission for ACS between 2003-2013 were identified in the UK MINAP database. COPD patients had a record of obstructive airway disease, smoking history and were aged >35. GRACE scores were calculated using a previously validated method1 and converted to predicted risk of death. Discrimination (c-statistic) and calibration (Hosmer-Lemeshow Chi2) measures were calculated for COPD and non-COPD patients. We then used logistic regression adjusted for GRACE score to compare management for COPD and non-COPD patients with the same GRACE score.

Results

483798 patients with ACS were identified. 58940 (12.2%) had COPD. Discrimination and calibration of GRACE scores were poorer for COPD patients (Table 1). Compared to non-COPD patients with the same GRACE score, COPD patients were under-treated and under-investigated (Table 2).

Conclusions

GRACE scores do not perform as well in COPD patients compared to non-COPD patients. COPD patients are less likely than non-COPD patients with the same risk of death to receive guideline recommended treatment and investigation.

Table 1 Performance of GRACE scores

C-statistic Hosmer-Lemeshow Chi2 (p-value) COPD 0.769 464.47 (<0.001) Non-COPD 0.823 71.71 (<0.001)

Table 2 Investigation and secondary prevention adjusted for GRACE score

OR (95% CI) Angiography 0.74 (0.71-0.77) Statin 0.92 (0.89-0.95) Aspirin 0.88 (0.86-0.90) Beta-blocker 0.32 (0.32-0.33)

1. Simms et al. Heart. 2013; 99:35.