Is a GRACE 3.0 needed?

In this issue of the Journal, Sergio Raposeiras-Roubín et al. present an original study that identifies the Global Registry of Acute Coronary Events (GRACE) risk score as an independent predictor of 30-day mortality and major cardiovascular events in patients with acute coronary syndrome (ACS). The ability to identify patients at risk for clinical events that endanger their lives or worsen their prognosis is one of the most important goals in medicine. But this goal makes more sense if identifying at-risk patients leads to therapeutic strategies that reduce the risk. This is the rationale behind risk scores, diagnostic tools that improve physicians’ ability not only to identify high-risk patients but to select the most appropriate strategies to reduce risk. Of the available scores for estimating risk associated with ACS, the GRACE score appears to be the best. It has been validated for identifying ACS patients at risk of in-hospital and six-month mortality, and according to Raposeiras-Roubín et al., it can also be used to identify ACS patients at risk of death and cardiovascular events within 30 days. First of all, the authors are to be congratulated on the low event rate in their study; in an all-comer population admitted and treated between 2004 and 2010, 30% (n=1332)