Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundThe GRACE (Global Registry of Acute Coronary Events) score is well validated for risk stratification in non–ST‐segment–elevation myocardial infarction, but less well established in ST‐segment–elevation myocardial infarction (STEMI), particularly relative to coronary disease burden. We therefore assessed its prognostic performance in a STEMI cohort, accounting for baseline coronary disease extent.MethodsWe studied 1099 patients with STEMI from the CardioLines Coronary Biobank (2015–2021) with evaluable GRACE score and follow‐up data. Patients were stratified by the number of coronary vessels with significant stenosis. The primary end point was all‐cause death at 1 year; the secondary end point was a combined end point, including all‐cause death, recurrent acute coronary syndrome, stroke, and revascularization at 1 year.ResultsMean GRACE scores increased with the number of diseased vessels (P<0.001). In multivariable models, each 10‐point increase in GRACE score was associated with a 31% higher risk of all‐cause death and a 14% higher risk of the combined end point at 1 year.
Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundThe GRACE (Global Registry of Acute Coronary Events) score is well validated for risk stratification in non–ST‐segment–elevation myocardial infarction, but less well established in ST‐segment–elevation myocardial infarction (STEMI), particularly relative to coronary disease burden. We therefore assessed its prognostic performance in a STEMI cohort, accounting for baseline coronary disease extent.MethodsWe studied 1099 patients with STEMI from the CardioLines Coronary Biobank (2015–2021) with evaluable GRACE score and follow‐up data. Patients were stratified by the number of coronary vessels with significant stenosis. The primary end point was all‐cause death at 1 year; the secondary end point was a combined end point, including all‐cause death, recurrent acute coronary syndrome, stroke, and revascularization at 1 year.ResultsMean GRACE scores increased with the number of diseased vessels (P<0.001). In multivariable models, each 10‐point increase in GRACE score was associated with a 31% higher risk of all‐cause death and a 14% higher risk of the combined end point at 1 year. In single‐vessel disease, discrimination for all‐cause death was excellent early (30‐day area under the curve, 0.874 [95% CI, 0.755–0.991]) and moderate at 1 year (area under the curve, 0.77 [95% CI, 0.613–0.927]), but consistently poor in 3‐vessel disease (area under the curve, 0.52–0.57). Discrimination was significantly higher in single‐ versus multivessel disease at earlier time points, with differences attenuated by 1 year. Stratified regression analyses confirmed stronger associations in single‐vessel versus multivessel disease.ConclusionsIn this contemporary STEMI cohort, the GRACE score effectively stratifies event risk in single‐vessel but performs poorly in multivessel disease. These findings suggest variable prognostic utility of the GRACE score across anatomic disease burden post‐STEMI and caution when applying it across STEMI subgroups.