GRACE and TIMI scores in predicting the extension of coronary artery disease in patients with non-ST elevation myocardial infarction

Abstract

Objective: We aimed to assess the correlation of TIMI and GRACE risk scores with the SYNTAX score as the surrogate of severity and extent of coronary artery disease.

Methods: Patients with non-ST elevation myocardial infarction admitted to our emergency department and undergoing coronary angiography were considered for this study. TIMI and GRACE risk scores were calculated, and coronary artery disease severity and extension were assessed by using the SYNTAX score algorithm.

Results: We assessed 145 patients (mean age 59.41±11.04 years, 29% female). Based on the GRACE risk score for in-hospital deaths, the SYNTAX risk score was 12.22±8.70 for the low-risk group, 16.66±8.01 for the intermediate-risk group, and 22.48±11.42 for the high-risk group (ANOVA, p<0.0001). There were significant positive correlations between the SYNTAX score and GRACE scores (r=0.414, p<0.0001). The SYNTAX score also had a significant but weaker correlation with the TIMI score (r=0.271, p=0.001). The GRACE score showed good discriminatory capacity between the patients with and without a high-risk (>33) SYNTAX score, with an area under the ROC curve of 0.804 (CI 0.660-0.948, p=0.002); however, the TIMI score showed no predictive capacity and had an area under the ROC curve of 0.532 (CI 0.358-0.749, p=0.749).

Conclusion: A GRACE score indicating high risk may be helpful in predicting patients with severe extended coronary artery disease

Key words: Coronary artery disease, non-ST elevation myocardial infarction, risk scores

Keywords

• Coronary artery disease, non-ST elevation myocardial infarction, risk scores

ST yükselmesiz miyokard enfarktüsü hastalarında koroner arter hastalığı yaygınlığının GRACE ve TIMI skorlarıyla öngörülmesi

Abstract

Amaç: TIMI ve GRACE risk skorlarının koroner arter hastalığının ciddiyetinin ve yaygınlığının bir göstergesi olan SYNTAX skoru ile korelasyonunu değerlendirmeyi amaçladık.Yöntemler: ST elevasyonsuz miyokard infarktüsü nedeniyle acilimize başvuran ve koroner anjiyografi yapılan hastalar çalışmaya alındı. TIMI ve GRACE risk skorları hesaplandı, koroner arter hastalığının ciddiyeti ve yaygınlığı SYNTAX skor algoritması kullanılarak değerlendirildi.Bulgular: 145 hastayı (ortalama yaş 59,41±11.04 yıl, %29 bayan) değerlendirdik. GRACE risk skoru baz alındığında hastane içi ölüm için düşük riskli grupta SYNTAX skoru 12,22±8,70, orta riskli olanlarda 16,66±8,01, yüksek riskli olanlarda 22,48±11,42 idi (ANOVA, p<0,0001). SYNTAX skorları ve GRACE skorları arasında anlamlı pozitif korelasyon vardı (r=0,414, p<0,0001). SYNTAX skoru ile TIMI skoru arasında anlamlı ama daha zayıf bir korelasyon vardı (r=0,271, p=0,001). GRACE skoru yüksek (>33) SYNTAX skoru olan ve olmayan hastalar için iyi bir ayırt etme kapasitesi göstermiştir, ROC eğrisi altında alan 0,804 (CI 0,660-0,948, p=0,002); fakat TIMI skoru ayırt etme kapasitesi göstermedi, ROC eğrisi altındaki alan 0,532 (CI 0,358-0,749, p=0,749) idi.Sonuç: Yüksek GRACE risk skoru ciddi ve yaygın koroner arter hastalığı olan hastaları öngörmede faydalı olabilir

Keywords

• Koroner arter hastalığı, ST elevasyonsuz miyokard infarktüsü, risk skoru

References

1. Antman E, Cohen M, Berninck P, et al. The TIMI risk score for
2. unstable/non-ST elevation MI. A method for prognostication and
3. therapeutic decision making. JAMA 2000;284:835-842.
4. Yan AT, Yan RT, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J 2007;28:1072-1078.
5. Granger CB, Goldberg RJ, Dabbous O, et al. Global Registry of
6. Acute Coronary Events Investigators. Predictors of hospital
7. mortality in the global registry of acute coronary events. Arch
8. Intern Med 2003;163:2345-2353.

9. Acet H, Ertas F, Bilik MZ, et al. The relationship between neutrophil to lymphocyte ratio and SYNTAX score in patients with
10. ST-segment elevation myocardial infarction. J Clin Exp Invest
11. ;5:211-218.
12. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score:
13. an angiographic tool grading the complexity of coronary artery
14. disease. Euro Intervention 2005;1:219-227.
15. Serruys PW, Onuma Y, Garg S, et al. Assessment of the SYNTAX score in the Syntax study. Euro Intervention 2009;5:50-56.
16. Khot U, Nissen S. Is CURE a cure for acute coronary syndromes? Statistical versus clinical significance. J Am Coll Cardiol 2002;40:218-219.
17. Hongo RH, Ley J, Dick SE, Yee RR. The effect of clopidogrel
18. in combination with aspirin when given before coronary artery
19. bypass grafting. J Am Coll Cardiol 2002;40:231-237.
20. Mega JL, Morrow DA, Sabatine MS, et al. Correlation between
21. the TIMI risk score and high-risk angiographic findings in non-
22. ST-elevation acute coronary syndromes: observations from the
23. Platelet Receptor Inhibition in Ischemic Syndrome Management
24. in Patients Limited by Unstable Signs and Symptoms (PRISM-
25. PLUS) trial. Am Heart J 2005;149:846-850.
26. Garcia S, Canoniero M, Peter A, et al. Correlation of TIMI risk score with angiographic severity and extent of coronary artery disease in patients with non-ST-elevation acute coronary syndromes. Am J Cardiol 2004;93:813-816.
27. Barbosa CE, Viana M, Brito M, et al. Accuracy of the GRACE
28. and TIMI scores in predicting the angiographic severity of acute
29. coronary syndrome. Arq Bras Cardiol 2012;99:818-824.
30. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999-3054.
31. Wijns W, Kolh P, Danchin N, et al. Task Force on Myocardial
32. Revascularization of the European Society of Cardiology (ESC)
33. and the European Association for Cardio-Thoracic Surgery
34. (EACTS); European Association for Percutaneous Cardiovas
35. cular Interventions (EAPCI). Eur Heart J 2010;31:2501-2555.
36. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972.
37. Caracciolo EA, Davis KB, Sopko G, et al. Comparison of surgi
38. cal and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience. Circulation 1995;91:2335-2344.