Background: To establish a modified Global Registry of Acute Coronary
Events (GRACE) scoring system with an improved predictive performance compared
with the traditional GRACE scoring system. Methods: We identified 5512
patients who were hospitalized with a definite diagnosis of acute myocardial
infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center
of the First Affiliated Hospital of Xinjiang Medical University through the
hospital’s electronic medical record system. A total of 4561 patients were
enrolled after the inclusion and exclusion criteria were applied. The mean
follow-up was 51.8 23.4 months. The patients were divided into dead and
alive groups by endpoint events. The differences between the two groups were
compared using the two-sample t test and chi-square test. Adjusted
traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system
were included in a multifactorial COX regression model. The predictive
performance of the traditional and modified GRACE scoring systems was compared by
(Receiver Operating Characteristic) ROC curves. Results: Significant
differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE
score, and modified GRACE score were found between the dead and alive groups by
the two-sample t test. Comparison of the two groups by the chi-square
test revealed that the dead group had a higher incidence of males; higher cardiac
function class; a previous history of hypertension, diabetes, coronary artery
disease (CAD), or cerebrovascular disease; a history of smoking; the need for
intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel,
ticagrelor, and -blockers. The results were analyzed by a multifactorial
COX regression model, and after adjusting for confounders, age, cardiac function
class, history of CAD, use of aspirin and -blockers, and the modified
GRACE scoring system were found to be associated with all-cause mortality (ACM)
in patients with AMI. The ROC curve was used to compare the predictive
performance of the conventional GRACE scoring system with that of the modified
GRACE scoring system, and it was found that the modified GRACE scoring system
(Area Under Curve (AUC) = 0.809, p 0.001, 95% (Confidence Interval) CI (0.789–0.829))
was significantly better than the traditional GRACE scoring system (AUC = 0.786,
p 0.001, 95% CI (0.764–0.808)), the comparison between the two
scores was statistically significant (p 0.001). The change in the C
statistic after 10-fold crossover internal validation of the modified GRACE score
was not significant, and the integrated discrimination improvement (IDI) between
the old and new models was calculated with IDI = 0.019 0, suggesting that the
modified GRACE score has a positive improvement on the traditional GRACE score.
Conclusions: The modified GRACE scoring system, established by combining
B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with
ACM in patients with AMI, with a larger AUC and higher predictive value than the
traditional GRACE scoring system. Clinical Trial Registration:
NCT02737956.