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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

ROC curves for the TIMI and GRACE scores for predicting in-hospitaldeath. Area under the curve for the TIMI score = 0.867 and area underthe curve for the GRACE score = 0.871 (p = 0.71).
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f03: ROC curves for the TIMI and GRACE scores for predicting in-hospitaldeath. Area under the curve for the TIMI score = 0.867 and area underthe curve for the GRACE score = 0.871 (p = 0.71).

Mentions: The analysis of the discriminatory capacity with regard to the outcomein-hospital death showed similarity between the TIMI and GRACE scores,represented by C-statistics of 0.867 (95% CI = 0.76-0.98) and 0.871 (95% CI =0.75 - 0.99), respectively, which indicated good accuracy in both cases (p =0.71; Figure 3). In our sample, theoptimal cutoff-points according to the analysis of the ROC curve were TIMI >5 and GRACE >170. Based on these values, the two scores exhibited similarsensitivities: 75% (95% CI = 48%-93%) for the TIMI score and 81% (95% CI =54%-96%) for the GRACE score (p = 1.0). Similarly, the specificities were 86%(95% CI = 79%-91%) and 88% (95% CI = 81%-93%), respectively (p = 0.82; Table 2).


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)

ROC curves for the TIMI and GRACE scores for predicting in-hospitaldeath. Area under the curve for the TIMI score = 0.867 and area underthe curve for the GRACE score = 0.871 (p = 0.71).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f03: ROC curves for the TIMI and GRACE scores for predicting in-hospitaldeath. Area under the curve for the TIMI score = 0.867 and area underthe curve for the GRACE score = 0.871 (p = 0.71).
Mentions: The analysis of the discriminatory capacity with regard to the outcomein-hospital death showed similarity between the TIMI and GRACE scores,represented by C-statistics of 0.867 (95% CI = 0.76-0.98) and 0.871 (95% CI =0.75 - 0.99), respectively, which indicated good accuracy in both cases (p =0.71; Figure 3). In our sample, theoptimal cutoff-points according to the analysis of the ROC curve were TIMI >5 and GRACE >170. Based on these values, the two scores exhibited similarsensitivities: 75% (95% CI = 48%-93%) for the TIMI score and 81% (95% CI =54%-96%) for the GRACE score (p = 1.0). Similarly, the specificities were 86%(95% CI = 79%-91%) and 88% (95% CI = 81%-93%), respectively (p = 0.82; Table 2).

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