Key result
GRACE score outperforms TIMI with ~98% diagnostic accuracy for predicting NSTEMI mortality.
Why the study?
Early death in NSTEMI is usually due to arrhythmia and patients should be admitted promptly; the diagnostic accuracy of TIMI versus GRACE scores for predicting death in NSTEMI patients needed comparison.
Does the GRACE score improve diagnostic accuracy for the prediction of death compared to the TIMI score in patients presenting with NSTEMI?
Cross-Sectional (n=372)
No
Does the GRACE score improve diagnostic accuracy for the prediction of death compared to the TIMI score in patients presenting with NSTEMI?
Absolute Event Rate: 97.85% vs 95.16%
The GRACE risk score provides higher diagnostic accuracy and sensitivity than the TIMI risk score for predicting death in patients presenting with NSTEMI.
Supports preferring GRACE over TIMI for NSTEMI mortality prediction; hypothesis-generating and requires prospective confirmation.
Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a significant risk of death. Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction. Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients. Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%. Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.
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A 2019 study conducted a cross-sectional in Acute Non-ST Elevation Myocardial Infarction (NSTEMI) (n=372). GRACE score vs. TIMI score was evaluated on diagnostic accuracy for prediction of death. The GRACE score demonstrated higher diagnostic accuracy (97.85% vs 95.16%) and sensitivity (100% vs 97.7%) than the TIMI score for predicting death in patients with NSTEMI.
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