Key result
GRACE risk scores outperform TIMI across ACS subtypes, achieving pooled c-statistics of ~0.83.
Why the study?
Acute coronary syndromes represent a difficult challenge for physicians, and risk scores have become the cornerstone of clinical and interventional decision making.
Does the GRACE risk score improve risk stratification accuracy (c-statistic) compared to TIMI and alternative risk scores in patients with Acute Coronary Syndromes?
Meta-Analysis (n=248,177)
Does the GRACE risk score improve risk stratification accuracy (c-statistic) compared to TIMI and alternative risk scores in patients with Acute Coronary Syndromes?
This meta-analysis demonstrates that while TIMI and GRACE are the most extensively investigated risk scores in acute coronary syndromes, the GRACE score consistently provides superior discriminative performance across short- and long-term follow-up.
Answers are grounded in this paper and cite their sources.
Supports GRACE over TIMI for ACS risk stratification; leaves open effects on clinical decisions and outcomes.
Background Acute coronary syndromes (ACS) represent a difficult challenge for physicians. Risk scores have become the cornerstone in clinical and interventional decision making. Methods and results PubMed was systematically searched for ACS risk score studies. They were divided into ACS studies (evaluating Unstable Angina; UA, Non ST Segment Elevation Myocardial Infarction; NSTEMI, and ST Segment Elevation Myocardial Infarction; STEMI), UA/NSTEMI studies or STEMI studies. The c-statistics of validation studies were pooled when appropriate with random-effect methods. 7 derivation studies with 25,525 ACS patients and 15 validation studies including 257,654 people were formally appraised. Pooled analysis of GRACE scores, both at short (0.82; 0.80-0.89 I.C 95%) and long term follow up (0.84; 0.82-0.87; I.C 95%) showed the best performance, with similar results to Simple Risk Index (SRI) derivation cohorts at short term. For NSTEMI/UA, 18 derivation studies with 56,560 patients and 18 validation cohorts with 56,673 patients were included. Pooled analysis of validations studies showed c-statistics of 0.54 (95% CI = 0.52-0.57) and 0.67 (95% CI = 0.62-0.71) for short and long term TIMI validation studies, and 0.83 (95% CI = 0.79-9.87) and 0.80 (95% CI = 0.74-0.89) for short and long term GRACE studies. For STEMI, 15 studies with 134,557 patients with derivation scores, and 17 validation studies with 187,619 patients showed a pooled c-statistic of 0.77 (95% CI = 0.71-0.83) and 0.77 (95% CI = 0.72-0.85) for TIMI at short and long term, and a pooled c-statistic of 0.82 (95% CI = 0.81-0.83) and 0.81 (95% CI = 0.80-0.82) for GRACE at short and long terms respectively. Conclusions TIMI and GRACE are the risk scores that up until now have been most extensively investigated, with GRACE performing better. There are other potentially useful ACS risk scores available however these have not undergone rigorous validation. This study suggests that these other scores may be potentially useful and should be further researched.
No takes yet. Share an insight, caveat, or question.
D’Ascenzo et al. (2012) conducted a meta-analysis in Acute Coronary Syndromes (ACS), including Unstable Angina (UA), NSTEMI, and STEMI (n=248,177). GRACE risk score vs. TIMI and alternative ACS risk scores (including Simple Risk Index) was evaluated on Pooled c-statistic for prognostic discrimination in ACS validation studies (c-statistic 0.82 (short-term) and 0.84 (long-term), 95% CI 0.80-0.89 (short-term); 0.82-0.87 (long-term)). GRACE risk scores outperformed TIMI across ACS subtypes, achieving pooled c-statistics of 0.82 at short term and 0.84 at long term.
Synapse has enriched 10 related papers. Consider them for comparative context: