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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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Distribution of the risk strata according to the TIMI and GRACEscores.
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f02: Distribution of the risk strata according to the TIMI and GRACEscores.

Mentions: The values of the TIMI and GRACE scores followed normal distribution. The meanTIMI score was 3.7 ± 2.3, which corresponded to a mortality of7%6 and indicatedintermediate risk, whereas the mean GRACE score was 116 ± 36, whichcorresponded to a mortality of 1.6%2 and suggested low risk. We used the cutoff-points determinedby the score validation studies to define low (< 3%), intermediate (3%-8%),and high (> 8%) risk, and we observed that the prevalence of these riskstrata according to TIMI were 39%, 27%, and 34%, respectively, which showed abalanced distribution of patients across risk strata. On the other hand, thedistribution of patients according to the cutoff-points of the GRACE score wasasymmetric, with 80% in the low-risk stratum, 13% in the intermediate-riskstratum, and 7% in the high-risk stratum (Figure2).


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)

Distribution of the risk strata according to the TIMI and GRACEscores.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f02: Distribution of the risk strata according to the TIMI and GRACEscores.
Mentions: The values of the TIMI and GRACE scores followed normal distribution. The meanTIMI score was 3.7 ± 2.3, which corresponded to a mortality of7%6 and indicatedintermediate risk, whereas the mean GRACE score was 116 ± 36, whichcorresponded to a mortality of 1.6%2 and suggested low risk. We used the cutoff-points determinedby the score validation studies to define low (< 3%), intermediate (3%-8%),and high (> 8%) risk, and we observed that the prevalence of these riskstrata according to TIMI were 39%, 27%, and 34%, respectively, which showed abalanced distribution of patients across risk strata. On the other hand, thedistribution of patients according to the cutoff-points of the GRACE score wasasymmetric, with 80% in the low-risk stratum, 13% in the intermediate-riskstratum, and 7% in the high-risk stratum (Figure2).

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