Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome

Abstract

Objective:The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS).Methods:Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS.Results:Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD.Conclusion:The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.

ST segment change and T wave amplitude ratio in lead aVR associated with coronary artery disease severity in patients with non-ST elevation myocardial infarction

“…[ 18 ] There are studies indicating that SS is higher in the high risk group in current scoring system. [ 19 , 20 ] Some studies detected higher SS levels in the elder patients with diabetes, bad renal functions, and NSTEMI. [ 21 – 23 ] The average age of the patients in the present study was <65; renal functions were at the upper limit and half of them were diabetic.…”

Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…It is widely accepted that the TIMI risk score is one of the most important scoring systems, preferred for risk stratification in patients with ACS, and is shown to be beneficial in many studies with large patient populations [11]. TIMI and GRACE scores are useful for the initial classification of NSTE-ACS patients, but they are not optimized for patients with PCI due to the lack of angiographic findings in these scoring systems.…”

A 6-Month Follow-Up Study of the Relation between Apolipoprotein E Gene Polymorphism and Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome

“…MACE (cardiac death, nonfatal MI or unplanned revascularization, and heart failure) is the gold standard for evaluating the prognosis. Although several ACS risk prediction tools (TIMI, PURSIT, GRACE) have been proposed in recent years, the most robust one for evaluating ischemia is GRACE, though GRACE may have some limitations [14,15]. This risk algorithm is recommended by contemporary guidelines and has been incorporated into clinical practice with potential improvements in decision-making.…”