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Invited Commentary
December 9, 2020

Risk Stratification Science Goes to a New Level

Author Affiliations
  • 1Department of Medicine, Stanford University, Stanford, California
  • 2Department of Medicine, Duke University, Durham, North Carolina
JAMA Cardiol. 2021;6(3):314-315. doi:10.1001/jamacardio.2020.6325

In this issue of JAMA Cardiology, Chew and colleagues1 present the primary results of a cluster randomized trial (the Australian GRACE Risk Score Intervention Study [AGRIS]), which compared routine clinical care with a strategy of risk stratification and implementation of evidence-based therapies using the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) among patients presenting to Australian hospitals with an acute coronary syndrome (ACS), either with ST elevation (STE) or without. The primary outcome was a clinical performance score based on guideline-based therapies (early invasive strategy, discharge medications, and cardiac rehabilitation referral). The authors1 report no difference in the receipt of all 3 measures between the 2 study arms, although use of the GRS was associated with an increased use of an early invasive strategy compared with the control group. There was no difference between the groups in the occurrence of the composite of death or myocardial infarction at 12 months.

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