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Prognostic value of TIMI score versus GRACE score in ST-segment elevation myocardial infarction.

Correia LC, Garcia G, Kalil F, Ferreira F, Carvalhal M, Oliveira R, Silva A, Vasconcelos I, Henri C, Noya-Rabelo M - Arq. Bras. Cardiol. (2014)

Bottom Line: This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE.These findings need to be validated populations of different risk profiles.

View Article: PubMed Central - PubMed

Affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.

ABSTRACT

Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome.

Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI.

Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death.

Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.

Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

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Related in: MedlinePlus

Statistical analysis diagram.
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f01: Statistical analysis diagram.

Mentions: The statistical analysis is explained in the diagram of Figure 1. The discriminatory ability of the scores withregard to risk of in-hospital death was assessed using ROC curves. The areaunder the ROC curve (C-statistics) represented the accuracy of each score todiscriminate the survivors from the non survivors. C-statistics of the twoscores were compared pairwise using the Hanley-McNeil test10. Next, the optimalcutoff-points for each score were determined. Specificity was defined as themaximum difference between sensitivity and 1. These cutoff-points were used tocalculate the prognostic sensitivity and specificity (confidence intervals setat 95%). The McNemar test was used to compare these parameters in the twoscores. Score calibration was evaluated by the Hosmer-Lemeshow test and by thescatter plot of predicted mortality by risk deciles versus observedmortality.


Prognostic value of TIMI score versus GRACE score in ST-segment elevation myocardial infarction.

Correia LC, Garcia G, Kalil F, Ferreira F, Carvalhal M, Oliveira R, Silva A, Vasconcelos I, Henri C, Noya-Rabelo M - Arq. Bras. Cardiol. (2014)

Statistical analysis diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150660&req=5

f01: Statistical analysis diagram.
Mentions: The statistical analysis is explained in the diagram of Figure 1. The discriminatory ability of the scores withregard to risk of in-hospital death was assessed using ROC curves. The areaunder the ROC curve (C-statistics) represented the accuracy of each score todiscriminate the survivors from the non survivors. C-statistics of the twoscores were compared pairwise using the Hanley-McNeil test10. Next, the optimalcutoff-points for each score were determined. Specificity was defined as themaximum difference between sensitivity and 1. These cutoff-points were used tocalculate the prognostic sensitivity and specificity (confidence intervals setat 95%). The McNemar test was used to compare these parameters in the twoscores. Score calibration was evaluated by the Hosmer-Lemeshow test and by thescatter plot of predicted mortality by risk deciles versus observedmortality.

Bottom Line: This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE.These findings need to be validated populations of different risk profiles.

View Article: PubMed Central - PubMed

Affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.

ABSTRACT

Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome.

Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI.

Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death.

Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.

Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Show MeSH
Related in: MedlinePlus