Risk-Prediction Model for Ischemic Stroke in Patients Hospitalized With an Acute Coronary Syndrome (from the Global Registry of Acute Coronary Events [GRACE])

UMMS Affiliation

Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine; Department of Surgery; Department of Quantitative Health Sciences

Publication Date


Document Type



Acute Coronary Syndrome; Stroke


Cardiovascular Diseases | Health Services Research


The risk of stroke in patients hospitalized with an acute coronary syndrome (ACS) ranges from <1% to ≥2.5%. The aim of this study was to develop a simple predictive tool for bedside risk estimation of in-hospital ischemic stroke in patients with ACS to help guide clinicians in the acute management of these high-risk patients. Data were obtained from 63,118 patients enrolled from April 1999 to December 2007 in the Global Registry of Acute Coronary Events (GRACE), a multinational registry involving 126 hospitals in 14 countries. A regression model was developed to predict the occurrence of in-hospital ischemic stroke in patients hospitalized with an ACS. The main study outcome was the development of ischemic stroke during the index hospitalization for an ACS. Eight risk factors for stroke were identified: older age, atrial fibrillation on index electrocardiogram, positive initial cardiac biomarkers, presenting systolic blood pressure ≥160 mm Hg, ST-segment change on index electrocardiogram, no history of smoking, higher Killip class, and lower body weight (c-statistic 0.7). The addition of coronary artery bypass graft surgery and percutaneous coronary intervention into the model increased the prediction of stroke risk. In conclusion, the GRACE stroke risk score is a simple tool for predicting in-hospital ischemic stroke risk in patients admitted for the entire spectrum of ACS, which is widely applicable to patients in various hospital settings and will assist in the management of high-risk patients with ACS.

Copyright © 2012 Elsevier Inc. All rights reserved.

DOI of Published Version



Am J Cardiol. 2012 Sep 1;110(5):628-35. Epub 2012 May 19. DOI:10.1016/j.amjcard.2012.04.040

Journal/Book/Conference Title

The American journal of cardiology

Related Resources

Link to article in PubMed

PubMed ID