Key result
GRACE score strongly outperforms TIMI score for predicting in-hospital mortality in NSTE-ACS patients.
Why the study?
The study was conducted to compare the predictive value of the TIMI and GRACE risk scores for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome.
Does the GRACE score have better predictive value than the TIMI score for in-hospital mortality in patients with NSTE-ACS?
Cohort (n=300)
No
Does the GRACE score have better predictive value than the TIMI score for in-hospital mortality in patients with NSTE-ACS?
The GRACE score demonstrates high discriminating strength (AUC 0.851) for predicting in-hospital mortality after NSTE-ACS, outperforming the TIMI score.
GRACE may be preferred over TIMI for in-hospital mortality prediction in NSTE-ACS; hypothesis-generating in this cohort and warrants further validation.
Objectives: To compare the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). Methodology: This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center of Karachi, Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores. Results: A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04±10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19±33.17 and 3.18±0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cut-off value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cut-off value of 4 with sensitivity of 75.0% and specificity of 67.6%. Conclusion: The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.
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Kumar et al. (2022) conducted a cohort in non-ST elevation acute coronary syndrome (NSTE-ACS) (n=300). GRACE score vs. TIMI score was evaluated on In-hospital mortality (AUC 0.851, 95% CI 0.767 - 0.934). The GRACE score demonstrated high predictive value for in-hospital mortality in NSTE-ACS patients (AUC 0.851; 95% CI 0.767-0.934) compared to the TIMI score (AUC 0.781; 95% CI 0.671-0.891).
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