<p>Title GRACE scores in COPD patients with acute coronary syndromes: performance and impact on secondary prevention </p><p>Authors Kieran J Rothnie1, Liam Smeeth1, Emily Herrett1, Neil Pearce1, Harry Hemingway2, Jadwiga Wedzicha3, Adam Timmis4, Jennifer K Quint1 </p><p>Author affiliations</p><p>1. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine</p><p>2. Department of Epidemiology and Public Health, University College London</p><p>3. National Heart and Lung Institute, Imperial College London</p><p>4. Barts NIHR Biomedical Research Unit, Queen Mary University of London</p><p>Conflict of interest statement None</p><p>Allowed 1810 characters including spaces and title</p><p>Currently 1804 GRACE scores in COPD patients with acute coronary syndromes: performance and impact on secondary prevention </p><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusions</p><p>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.</p><p>Table 1 Performance of GRACE scores</p><p>C-statistic Hosmer-Lemeshow Chi2 (p-value) COPD 0.769 464.47 (<0.001) Non-COPD 0.823 71.71 (<0.001)</p><p>Table 2 Investigation and secondary prevention adjusted for GRACE score</p><p>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)</p><p>1. Simms et al. Heart. 2013; 99:35.</p>