Predictive Strength of GRACE and CHA2DS2-VASc in Patients with Atrial Fibrillation After PCI

Findings from a study, published in Annals of Medicine, assessed the performance of the Global Registry of Acute Coronary Events (GRACE) and the Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes, prior Stroke or transient ischemic attack (doubled), Vascular disease, Age 65–74 years, Sex (CHA2DS2-VASc) scores for predicting risk of major adverse cardiac events (MACEs) in patients with atrial fibrillation (AFib) undergoing percutaneous coronary intervention (PCI).


Lead study author, Tingting Guo, presented their conclusion: “high GRACE score but not CHA2DS2-VASc score were both associated with an increased risk of MACEs after PCI in patients with AF.” Guo further noted that “the GRACE and CHA2DS2-VASc cores have similar predictive performance for predicting all-cause mortality.” The GRACE score could also help identify patients at higher risk of stroke and major bleeding, according to the study.


The researchers enrolled patients with AFib admitted to the Fuwai Hospital for PCI between January 2016 and December 2018 and followed up for at least one year. The primary outcome tracked was MACE incidence, including all-cause mortality, repeat revascularization, myocardial infarction, or ischemic stroke.


A total of 1,452 patients were included in the study. Researchers observed that GRACE (hazard ratio [HR] = 1.014, 95% confidence interval [CI] 1.008–1.020, P <0.001) score, though not CHA2DS2-VASc score, was associated with the risk of MACEs. Both GRACE and CHA2DS2-VASc scores were predictive of all-cause mortality, with HRs of 1.028 (95% CI 1.020–1.037, P = 0.001) and 1.334 (95% CI 1.107–1.632, P = 0.003), respectively. Both scales had similar efficacy in predicting all-cause mortality (C-statistic: 0.708 for GRACE versus. 0.661 for CHA2DS2-VASc, P = 0.299). While a high GRACE score was also significantly associated with increased risk of ischemic stroke (HR = 1.018, 95% CI 1.005–1.031, P = 0.006) and major bleeding (HR = 1.012, 95% CI 1.001–1.024, P = 0.039), high CHA2DS2-VASc score was not.


Authors noted that the study was limited by its single-center, retrospective design and called for further research to validate their findings in large cohorts. The study also did not record antithrombotic treatment regimens of patients.


In summary, the researchers found that increasing GRACE score but not CHA2DS2-VASc score was independently associated with a high risk of MACEs in patients with AFib after PCI. The risk scales both have similar predictive performance for predicting all-cause mortality. Notably, the authors suggested that GRACE scores could be useful for identifying patients at higher risk of stroke and major bleeding.