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. 2018 Jan;34(1):4-12.
doi: 10.6515/ACS.201801_34(1).20170730B.

TIMI and GRACE Risk Scores Predict Both Short-Term and Long-Term Outcomes in Chinese Patients with Acute Myocardial Infarction

Ying-Hwa Chen  1   2 , Shao-Sung Huang  1   2 , Shing-Jong Lin  3   4
Affiliations

TIMI and GRACE Risk Scores Predict Both Short-Term and Long-Term Outcomes in Chinese Patients with Acute Myocardial Infarction

Ying-Hwa Chen et al. Acta Cardiol Sin. 2018 Jan.

Abstract

Background: Little is known about the long-term prognostic values of both thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Cardiac Events (GRACE) risk scores (RSs) to the Asian ethnicity. The purpose of this study is to compare the usefulness of these two scores in risk stratification and prediction of long-term (up to 3 years) outcomes for Chinese patients with myocardial infarction (MI).

Methods: We calculated the TIMI and GRACE RSs for 726 consecutive patients with MI [55.6% with ST-segment elevation (STEMI) and 44.4% with non-ST-segment elevation (NSTEMI)].

Results: Although the risk profile of our population (median TIMI score = 5 for STEMI, 4 for NSTEMI, and median GRACE score = 164) was higher, the in-hospital mortality (7.1% for NSTEMI and 6.7% for STEMI) was comparable to that predicted by GRACE RS. The GRACE RS worked well in predicting short-term and long-term death (C-statistics range 0.710 to 0.789) and triple (death, MI, and stroke) endpoints (C-statistics range 0.695 to 0.764) in both subsets of MI. GRACE RS performed significantly better than the TIMIRS in predicting 3-year mortality in NSTEMI (p = 0.035) and 1-year and 3-year mortality in STEMI (p = 0.028 and 0.009, respectively). Stratification by tertiles of GRACERS furnished greater prognostic information versus risk assessment by the TIMI RS.

Conclusions: The use of RSs revealed a fair to good discriminatory accuracy in predicting both short-term and long-term major adverse cardiac events in Asian patients with MI. Compared with the simpler TIMI RS, the GRACERS was more accurate in predicting long-term mortality.

Keywords: GRACE risk score; Myocardial infarction; Prognosis; Risk stratification; TIMI risk score.

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Figures

Figure 1
Figure 1
Rates of death and composite endpoints of death, myocardial (re-)infarction, or stroke for patients with STEMI (A) and NSTEMI (B) at all analyzed time points in low-, intermediate-, and high-risk groups by TIMI risk score (tertiles). p values are for trend. * p < 0.05, # p < 0.01, and † p < 0.001. NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction.
Figure 2
Figure 2
Rates of death and composite endpoints of death, myocardial (re-)infarction, or stroke for patients with STEMI (A) and NSTEMI (B) at all analyzed time points in low-, intermediate-, and high-risk groups by GRACE risk score (tertiles). p values are for trend. * p < 0.05, # p < 0.01, and † p < 0.001. Abbreviations are in Figure 1.
Figure 3
Figure 3
Observed (i.e., actual) vs. predicted in-hospital mortality rates of our patients compared to those of the validation subsets. Abbreviations are in Figure 1.
See this image and copyright information in PMC

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