Key result
GRACE and TIMI risk scores show good predictive accuracy in Southeast Asian AMI patients.
Why the study?
Cultural and genetic diversity in Southeast Asian populations creates distinct cardiovascular risks and prognosis compared to Western populations, raising concerns about existing prognostic models' accuracy.
Do prognostic risk models like GRACE and TIMI accurately predict secondary cardiovascular events in Southeast Asian populations with acute myocardial infarction?
Systematic Review
Do prognostic risk models like GRACE and TIMI accurately predict secondary cardiovascular events in Southeast Asian populations with acute myocardial infarction?
Both TIMI and GRACE risk scores demonstrated good predictive accuracies for secondary events in Southeast Asian populations with AMI, though evidence quality is limited by study heterogeneity.
Supports GRACE/TIMI use for AMI risk stratification in Southeast Asians; extends validation to this population.
Background The cultural and genetic diversity of the Southeast Asian population has contributed to distinct cardiovascular disease risks, incidence, and prognosis compared to the Western population, thereby raising concerns about the accuracy of predicted risks of existing prognostic models. Objectives We aimed to evaluate the predictive performances of validated, recalibrated, and developed prognostic risk prediction tools used in the Southeast Asian population with acute myocardial infarction (AMI) events for secondary events Methods We searched MEDLINE and Cochrane Central databases until March 2022. We included prospective and retrospective cohort studies that exclusively evaluated populations in the Southeast Asian region with a confirmed diagnosis of an AMI event and evaluated for risk of secondary events such as mortality, recurrent AMI, and heart failure admission. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review. Results We included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. Both short- and long-term outcomes were assessed. Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. The pooled estimate of the C-statistic in the Southeast Asian population for GRACE risk score is 0.83 (95%CI 0.72–0.90, n = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772–0.83, n = 5 validations). Recalibrated and new models demonstrated marginal improvements in discriminative values. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies. Conclusion Both TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, with the limited strength of evidence, these results should be interpreted with caution. Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486 .
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Ismail et al. (2022) conducted a systematic review in Acute myocardial infarction. GRACE risk score was evaluated on Pooled C-statistic for predictive accuracy (C-statistic 0.83, 95% CI 0.72-0.90). The GRACE and TIMI risk scores demonstrated good predictive accuracies in Southeast Asian populations with acute myocardial infarction, with pooled C-statistics of 0.83 and 0.80, respectively.
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