Key result
GRACE score linked to ~220% higher mortality odds, outperforming TIMI and shock indices in STEMI.
Why the study?
Proper risk stratification is critical to guide early management in STEMI, and simpler bedside indices like SI, MSI, Age SI, and MBG needed comparison against traditional TIMI and GRACE scores for predicting outcomes.
Does the GRACE score improve prediction of mortality and MACE compared to TIMI and shock-based indices in STEMI patients undergoing reperfusion?
Observational (n=150)
No
Does the GRACE score improve prediction of mortality and MACE compared to TIMI and shock-based indices in STEMI patients undergoing reperfusion?
The GRACE score demonstrated superior prognostic value for predicting mortality and 30-day MACE in STEMI patients undergoing reperfusion compared to TIMI and shock-based indices.
Answers are grounded in this paper and cite their sources.
May aid STEMI risk stratification over TIMI; leaves open need for prospective validation before practice change.
Background and objective ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality globally. Proper risk stratification is critical to guide its early management and forecast outcomes. Although traditional scoring systems such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) are commonly employed, more recent indices such as Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age SI), and Myocardial Blush Grade (MBG) provide potentially more straightforward, bedside-usable means for prognostication. This study aimed to evaluate and compare the predictive validity of SI, Age SI, MSI, and MBG with validated risk scores - TIMI and GRACE - in predicting in-hospital and 30-day outcomes in STEMI patients who are undergoing reperfusion therapy. Methods This prospective observational study was conducted from September 2023 to August 2024 at R.L. Jalappa Hospital and RLJ Narayana Hrudayalaya, Kolar. A total of 150 adult STEMI patients treated with thrombolysis or primary percutaneous coronary intervention (PCI) were enrolled. Data were examined using chi-square tests and receiver operating characteristic (ROC) curves. Outcomes were assessed as in-hospital mortality, length of stay in ICU, and 30-day major adverse cardiac events (MACE). Results GRACE score evidenced higher predictive capacity for mortality and MACE over TIMI and shock-based indices. Age SI and MBG indicated encouraging correlation with outcomes, especially when employed in combination with conventional scores. Conclusions GRACE is a potent risk stratification tool for STEMI. Yet, SI-based metrics and MBG may supplement conventional scores, thereby providing fast, bedside assessment to facilitate early intervention and enhance patient outcomes in these patients.
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SR et al. (2025) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=150). GRACE score vs. TIMI score, Shock Index-based indices, and Myocardial Blush Grade was evaluated on Mortality (OR 3.2, p=<0.001). The GRACE risk score independently predicted mortality (OR 3.2) and demonstrated superior prognostic performance for 30-day adverse events in STEMI patients compared to TIMI and shock-based indices.
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