Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: Dr Fox and colleagues1 reported decreasing rates of death after hospitalization for ACS in the GRACE registry. They showed that crude in-hospital mortality for non–ST-segment elevation ACS remained unchanged over time, whereas a decline was seen when risk-adjusted rates were analyzed; this difference is due to a 5-point increase in the mean in-hospital risk score. The patients' characteristic with the largest change from 1999 to 2005 was the percentage of patients with positive initial enzyme levels (+17%). According to the method of risk quantification used in this study,2 the14 points assigned to elevated enzyme levels in the risk score suggests that this could explain nearly half of the mean change in risk score (14×0.17 = 2.4). Therefore, the increased use of troponin measurement may have significantly influenced the risk-adjusted comparisons between study periods.
Fedeli U, Brocco S, Spolaore P. Lower Rates of Heart Failure and Death in Acute Coronary Syndromes. JAMA. 2007;298(9):969-971. doi:10.1001/jama.298.9.970-a