Background Patients with prior cancer are at increased risk of acute coronary syndrome (ACS) with poorer post-ACS outcomes. We aimed to ascertain if the Global Registry of Acute Coronary Events (GRACE) score accurately predicts mortality risk among patients with ACS and prior cancer. Methods We linked nationwide ACS and cancer registries from 2007 to 2018 in Singapore. A total of 24,529 eligible patients had in-hospital and 1-year all-cause mortality risk calculated using the GRACE score (2471 prior cancer; 22,058 no cancer). Results Patients with prior cancer had two-fold higher all-cause mortality compared to patients without cancer (in-hospital: 22.8% versus 10.3%,p< 0.001; 1-year: 49.0% vs. 18.7%,p< 0.001). Cardiovascular mortality did not differ between groups (in-hospital: 5.2% vs. 4.8%,p= 0.346; 1-year: 6.9% vs. 6.1%,p= 0.12). The area under the receiver operating characteristic curve of the GRACE score for prediction of all-cause mortality was less for prior cancer (in-hospital: 0.64 vs. 0.80,p< 0.001; 1-year: 0.66 vs. 0.83,p< 0.001). Among patients with prior cancer and a high-risk GRACE score > 140, in-hospital revascularization was not associated with lower cardiovascular mortality than without in-hospital revascularization (6.7% vs. 7.6%,p= 0.50). Conclusions The GRACE score performs poorly in risk stratification of patients with prior cancer and ACS.
背景：既往有癌症病史的患者发生急性冠脉综合征（ACS）的风险增加，且ACS后预后更差。本研究旨在明确全球急性冠脉事件注册（GRACE）评分是否能准确预测既往有癌症病史的ACS患者的死亡风险。方法：我们关联了新加坡2007年至2018年的全国性ACS与癌症登记数据。共纳入24,529例符合条件的患者，使用GRACE评分计算其院内及1年全因死亡风险（其中2,471例有既往癌症病史；22,058例无癌症病史）。结果：与无癌症病史的患者相比，有既往癌症病史的患者全因死亡率高出两倍（院内：22.8% 对 10.3%，p < 0.001；1年：49.0% 对 18.7%，p < 0.001）。两组间心血管死亡率无显著差异（院内：5.2% 对 4.8%，p = 0.346；1年：6.9% 对 6.1%，p = 0.12）。GRACE评分预测全因死亡率的受试者工作特征曲线下面积在有既往癌症病史的患者中较低（院内：0.64 对 0.80，p < 0.001；1年：0.66 对 0.83，p < 0.001）。在GRACE评分高危（>140分）且有既往癌症病史的患者中，院内血运重建与未行院内血运重建相比，并未与更低的心血管死亡率相关（6.7% 对 7.6%，p = 0.50）。结论：GRACE评分在有既往癌症病史的ACS患者风险分层中表现不佳。
肿瘤(癌症)患者之家