ABC | Volume 112, Nº6, June 2019

Original Article Carvalhal et al. Does GRACE Score modulate invasiveness? Arq Bras Cardiol. 2019; 112(6):721-726 1. McAlister FA. The end of the risk-treatment paradox? a rising tide lifts all boats. J Am Coll Cardiol. 2011;58(17):1766-7. 2. Yan AT, Yan RT, Tan M, Casanova A, Labinaz M, Sridhar K, et al. Risk scores for risk stratification in acute coronary syndromes: Useful but simpler is not necessarily better. Eur Heart J. 2007;28(9):1072-8. 3. Yan AT, Yan RT, Huynh T, Casanova A, Raimondo FE, Fitchett DH, et al. Understanding physicians’ risk stratification of acute coronary syndromes: insights from the Canadian ACS 2 Registry. Arch Intern Med. 2011;169(4):372-8. 4. Weintraub WS. Prediction scores after myocardial infarction: value, limitations, and future directions. Circulation. 2002;106(18):2292-3. 5. De Bondt WFM, Thaler R. Does the stock market overreact? J Finance. 1985;40(3):793-805. 6. 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Clin Res Cardiol Suppl. 2013;8(suppl 1):20-4. 14. Wimmer NJ, Resnic FS, Mauri L, Matheny ME, Piemonte TC, Pomerantsev E, et al. Risk-treatment paradox in the selection of transradial access for percutaneous coronary intervention. J AmHeart Assoc . 2013;2(3):e000174. 15. Pierson DJ. Translating evidence into practice Respir Care. 2009;54(10):1386-401. 16. KoDT, Mamdani M, Alter DA. Lipid-lowering therapywith statins in high-risk elderly patients: the treatment-risk paradox. Jama. 2004;291(15):1864-70. References traditional prognostic marker, it may be acting as a proxy to a more fragile patient or one with more co-morbidities. The limitation of our study is the generalization from a single CCU. Actually, we utilized our Unit as a model to test the hypothesis that the use of GRACE Score influences decision towards a more aggressive approach. While our study should not be generalized as a demonstration that decision-making has not been properly based on risk, it is an evidence that the utilization of a risk model does not guarantee risk-based decision. Moreover, our observation is in line with previous evidences of risk-treatment paradox. 14,23 Finally, our findings only generate hypotheses to be further validated by a clinical trial, in which individuals would be allocated to utilization or no utilization of GRACE Score, and the frequency of the invasive strategy would be compared between the groups. Conclusion In conclusion, the dissociation between GRACE Score and invasive decision in ACS suggests that the utilization of a prognostic model does not guarantee a risk-based decision. Author contributions Conception and design of the research, Analysis and interpretation of the data, Statistical analysis andWriting of the manuscript: Carvalhal MC, Souza TMB, Suerdieck J, Lopes F, Correia VCA, Lacerda YF, Sá N, Sodré GS, Rabelo MMN, Correia LCL; Acquisition of data: Carvalhal MC, Souza TMB, Suerdieck J, Lopes F, Correia VCA, Lacerda YF, Sá N, Sodré GS, Correia LCL; Critical revision of the manuscript for intellectual content: Correia LCL. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of Hospital São Rafael under protocol number 35/11. All procedures involved in this study are in accordance with the Declaration of Helsinki of 1975, updated in 2013. Informed consent was obtained from all participants included in the study. 725