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TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS.
Eur Heart J. 2005 May; 26(9):865-72.EH

Abstract

AIMS

Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization.

METHODS AND RESULTS

We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63+/-11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672-0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584-0.674), and TIMI RS (AUC: 0.585; CI: 0.539-0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively.

CONCLUSION

The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

Authors+Show Affiliations

Cardiology Department, Santa Cruz Hospital, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal. paraujogoncalves@yahoo.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

15764619

Citation

de Araújo Gonçalves, Pedro, et al. "TIMI, PURSUIT, and GRACE Risk Scores: Sustained Prognostic Value and Interaction With Revascularization in NSTE-ACS." European Heart Journal, vol. 26, no. 9, 2005, pp. 865-72.
de Araújo Gonçalves P, Ferreira J, Aguiar C, et al. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J. 2005;26(9):865-72.
de Araújo Gonçalves, P., Ferreira, J., Aguiar, C., & Seabra-Gomes, R. (2005). TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. European Heart Journal, 26(9), 865-72.
de Araújo Gonçalves P, et al. TIMI, PURSUIT, and GRACE Risk Scores: Sustained Prognostic Value and Interaction With Revascularization in NSTE-ACS. Eur Heart J. 2005;26(9):865-72. PubMed PMID: 15764619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. AU - de Araújo Gonçalves,Pedro, AU - Ferreira,Jorge, AU - Aguiar,Carlos, AU - Seabra-Gomes,Ricardo, Y1 - 2005/03/11/ PY - 2005/3/15/pubmed PY - 2005/8/27/medline PY - 2005/3/15/entrez SP - 865 EP - 72 JF - European heart journal JO - Eur Heart J VL - 26 IS - 9 N2 - AIMS: Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. METHODS AND RESULTS: We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63+/-11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672-0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584-0.674), and TIMI RS (AUC: 0.585; CI: 0.539-0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. CONCLUSION: The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15764619/TIMI_PURSUIT_and_GRACE_risk_scores:_sustained_prognostic_value_and_interaction_with_revascularization_in_NSTE_ACS_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi187 DB - PRIME DP - Unbound Medicine ER -