Prognostic Value of the Grace Score in Patients Admitted for Acute Coronary Syndrome: An Observational Study of 94 Patients

Abstract

Acute coronary syndrome (ACS) is a major cardiovascular emergency associated with a significant risk of mortality and short- and long-term cardiovascular complications. The heterogeneity of clinical presentation necessitates early risk stratification to identify high-risk patients and tailor therapeutic management. The GRACE (Global Registry of Acute Coronary Events) score is one of the main validated tools for prognostic stratification in patients with ACS. We conducted a retrospective observational study of 94 patients hospitalised for ACS in the cardiology department of the Marrakech University Hospital. Demographic data, cardiovascular risk factors, and clinical, electrocardiographic, laboratory, and echocardiographic data were collected. The GRACE score was calculated at admission. Patients were stratified into risk categories according to standard cut-off points. The primary endpoint was in-hospital mortality. The discriminative performance of the GRACE score was assessed using receiver operating characteristic (ROC) analysis. The main cardiovascular risk factors were diabetes (51%), dyslipidaemia (49%), smoking (47%), and hypertension (35%). ACS with ST-segment elevation accounted for 62% of cases. The mean GRACE score was 134.2 ± 39.1 points and the median score was 132 (IQR, 114.5–138.5). In-hospital mortality was 13.8% (13/94). The GRACE score was significantly higher among patients who died than among survivors (208.9 ± 53.3 vs. 122.2 ± 17.4 points; p < 0.001). ROC analysis showed excellent discrimination for in-hospital mortality, with an AUC of 0.996 (95% CI, 0.985–1.000). In this single-centre Moroccan cohort, a higher GRACE score was strongly associated with in-hospital mortality and demonstrated excellent discrimination for this outcome. Given the small sample size and limited number of deaths, these findings should be considered preliminary and require external validation in larger multicentre Moroccan and North African cohorts.