Key result
GRACE and HEART scores predict in-hospital death and cardiogenic shock better than TIMI in NSTEMI.
Why the study?
NSTEMI patients exhibit a wide range of clinical consequences making risk assessment crucial, prompting a direct comparison of GRACE, HEART, and TIMI scores for predicting in-hospital outcomes.
Do the GRACE and HEART risk scores better predict in-hospital outcomes compared to the TIMI risk score in patients with NSTEMI?
Do the GRACE and HEART risk scores better predict in-hospital outcomes compared to the TIMI risk score in patients with NSTEMI?
In patients with NSTEMI, the HEART and GRACE risk scores demonstrated superior predictive accuracy for in-hospital outcomes, including death and cardiogenic shock, compared to the TIMI risk score.
May favor GRACE or HEART over TIMI for NSTEMI risk stratification; supports validations but leaves open impact on outcomes.
Background A major component of ACS, Non-ST segment elevation myocardial infarction (NSTEMI), has more than twice the incidence compared to ST-segment elevation myocardial infarction (STEMI). However, NSTEMI patients have a large range of clinical consequences, from minimal sequelae to early death. Risk assessment was crucial in guiding therapeutic decision-making. Three well-known risk scores are the GRACE score, the HEART score and the TIMI score. Purpose To compare the performance of the GRACE, HEART and TIMI scores in predicting the in hospital outcome among the NSTEMI patients Methods This prospective, observational, single-center study, was conducted for one year (November ,23 to October,24). Total 588 patients who admitted with Chest pain & diagnosed as NSTEMI, were included in the study consecutively. Patients’ demographic information and all variables necessary for calculating risk scores (GRACE, HEART& TIMI) were recorded. For GRACE score, patients who scored ≤ 108 points were low-risk, 109–139 points were medium-risk, ≥ 140 points were high-risk. For HEART scores, 0–3 scores were low-risk, while 4–6 scores were medium-risk and 7–10 score were high-risk group. For TIMI scores Patients with 0–2 scores were low-risk, while 3–4 scores were medium-risk and 5–7 score were high-risk groups. For assessment of in hospital outcome, ALVF, arrhythmia, cardiogenic shock& death were evaluated. Results Mean age of the study population was 57.9±11.2 years and male patients were predominant 70.4%. Among the study population. 35.7% patients developed ALVF, 6.6% developed cardiogenic shock, 2.2% patients developed arrhythmia & 2.9% were all cause mortality. For ALVF, The AUC of GRACE, HEART, and TIMI score are 0.78(95%CI 0.74-0.82), versus 0.76 (95% CI 0.62-0.80) versus 0.68(95%CI 0.64-0.73)); respectively; p < 0.001. For Cardiogenic shock, The AUC of GRACE, HEART, and TIMI 0.78(95%CI 0.71-0.86), versus 0.70 (95% CI 0.63-0.77) versus 0.67(95%CI 0.59-0.76)); respectively; p < 0.001. For in hospital Death, The AUC of GRACE, HEART, and TIMI score are 0.90(95%CI 0.874-0.940), versus 0.89 (95% CI 0.84-0.94) versus 0.84 (95% CI 0.820-0.923); respectively; p < 0.001 (all differences in AUC highly statistically significant). Conclusion In patients with NSTEMI, the HEART and GRACE risk scores can better predict in hospital outcome than the TIMI risk score.ROC curve for prection of ALVF ROC curve for prediction of Death
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Chowdhury et al. (2025) studied this question. In NSTEMI patients, GRACE and HEART scores predicted in-hospital death (AUC 0.90, 0.89) and cardiogenic shock better than TIMI score (AUC 0.84 death).
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