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Addition of B-type natriuretic peptide to the GRACE score to predict outcome in acute coronary syndrome: a retrospective (development) and prospective (validation) cohort-based study
  1. Thomas Guidez1,
  2. Sylvestre Maréchaux2,3,
  3. Claire Pinçon4,
  4. Hélène Lamour1,
  5. Stéphanie Barrailler1,
  6. Vincent Decourcelle1,
  7. Sophie Braun1,
  8. Nadia Bouabdallaoui1,
  9. Jean-Jacques Bauchart1,
  10. Jean Luc Auffray1,
  11. Bernadette Hennache1,
  12. Francis Juthier3,
  13. André Vincentelli3,
  14. Philippe Asseman1,
  15. Eric Van Belle3,
  16. Pierre Vladimir Ennezat1,3
  1. 1Centre Hospitalier Régional et Universitaire de Lille, Cardiology Emergency and Intensive Care Unit, Cardiology Hospital, Lille, France
  2. 2Groupement Hospitalier de l'Institut Catholique Lillois/Faculté libre de médecine, UCLille, Lille, France
  3. 3Université Lille Nord de France, Institut Fédératif de Recherche 114, Lille, France
  4. 4UDSL, EA 2694, Department of Biostatistics, Faculté de Pharmacie de Lille, Lille, France
  1. Correspondence to Pierre Vladimir Ennezat, Intensive Care Unit, Cardiology Hospital, Bd Pr J Leclerq, 59037 Lille cedex, France; ennezat{at} or Sylvestre Maréchaux, Cardiology and Intensive Care Unit, St Philibert Hospital Rue du Grand But 59462 Lomme Cedex, France; sylvestre.marechaux{at}


Aims The present study was designed to build and validate a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) concentrations to predict outcome in patients with acute coronary syndromes (ACS).

Methods The GRACE risk score and BNP concentrations were obtained in a retrospective and a prospective cohort. A composite score including the GRACE score and BNP concentrations was first developed in a retrospective cohort of 248 patients with ACS and then validated in a prospective cohort of 575 patients. The primary outcome was 6-month death or myocardial infarction.

Results End points were reached in 34 patients in the retrospective cohort and in 68 patients in the prospective cohort. Both higher BNP concentration and GRACE score were independently associated with outcome in the retrospective cohort (p=0.003 and p<0.0001). The composite score could be obtained as follows: GRACE+BNP/60. The use of the composite score increased the accuracy of the GRACE score, with an increase in the C statistic from 0.810 (0.727 to 0.892) to 0.822 (0.745 to 0.902) in the retrospective cohort and from 0.724 (0.657 to 0.791) to 0.750 (0.686 to 0.813) in the prospective cohort. Finally, 7% of patients in the prospective study population were reclassified from low to high risk or from high to low risk using this composite score.

Conclusions Plasma BNP levels refine the accuracy of the GRACE score. A comprehensive risk score, which includes BNP concentration and the GRACE risk score, might improve ACS risk stratification in clinical practice.

  • Acute coronary syndromes
  • BNP
  • prognosis
  • acute myocardial infarct
  • cardiac care

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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