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Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better.
Eur Heart J. 2007 May; 28(9):1072-8.EH

Abstract

AIMS

Our objectives were (i) to compare the discriminatory performance of the Thrombolysis in Myocardial Infarction risk score (TIMI RS), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy risk score (PURSUIT RS), and Global Registry of Acute Cardiac Events risk score (GRACE RS) for in-hospital and 1 year mortality across the broad spectrum of non-ST-elevation acute coronary syndromes (ACS) and (ii) to determine their incremental prognostic utility beyond overall risk assessment by physicians.

METHODS AND RESULTS

We calculated the TIMI RS, PURSUIT RS, and GRACE RS for 1,728 patients with non-ST-elevation ACS in the prospective, multicentre, Canadian ACS II Registry. Discriminatory performance was measured by the c-statistic (area under receiver-operating characteristic curve) and compared by the method described by DeLong. TIMI RS, PURSUIT RS, and GRACE RS all demonstrated good discrimination for in-hospital death (c-statistics = 0.68, 0.80, 0.81, respectively, all P < 0.001) and 1 year mortality (c-statistics = 0.69, 0.77, 0.79, respectively, all P < 0.0001). However, PURSUIT RS and GRACE RS performed significantly better than the TIMI RS in predicting in-hospital (P = 0.036 and 0.02, respectively) and 1 year (P = 0.006 and 0.001, respectively) outcomes. In multivariable analysis adjusting for the use of in-hospital revascularization, stratification by tertiles of risk scores (into low, intermediate, and high-risk groups) furnished independent and greater prognostic information compared with risk assessment by treating physicians for 1 year outcome.

CONCLUSION

Compared with TIMI RS, both PURSUIT RS and GRACE RS allow better discrimination for in-hospital and 1 year mortality in patients presenting with a wide range of ACS. All three risk scores confer additional important prognostic value beyond global risk assessment by physicians. These validated risk scores may refine risk stratification, thereby improving patient care in routine clinical practice.

Authors+Show Affiliations

Canadian Heart Research Centre, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17437970

Citation

Yan, Andrew T., et al. "Risk Scores for Risk Stratification in Acute Coronary Syndromes: Useful but Simpler Is Not Necessarily Better." European Heart Journal, vol. 28, no. 9, 2007, pp. 1072-8.
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(9):1072-8.
Yan, A. T., Yan, R. T., Tan, M., Casanova, A., Labinaz, M., Sridhar, K., Fitchett, D. H., Langer, A., & Goodman, S. G. (2007). Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. European Heart Journal, 28(9), 1072-8.
Yan AT, et al. Risk Scores for Risk Stratification in Acute Coronary Syndromes: Useful but Simpler Is Not Necessarily Better. Eur Heart J. 2007;28(9):1072-8. PubMed PMID: 17437970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. AU - Yan,Andrew T, AU - Yan,Raymond T, AU - Tan,Mary, AU - Casanova,Amparo, AU - Labinaz,Marino, AU - Sridhar,Kumar, AU - Fitchett,David H, AU - Langer,Anatoly, AU - Goodman,Shaun G, Y1 - 2007/04/16/ PY - 2007/4/18/pubmed PY - 2007/12/8/medline PY - 2007/4/18/entrez SP - 1072 EP - 8 JF - European heart journal JO - Eur Heart J VL - 28 IS - 9 N2 - AIMS: Our objectives were (i) to compare the discriminatory performance of the Thrombolysis in Myocardial Infarction risk score (TIMI RS), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy risk score (PURSUIT RS), and Global Registry of Acute Cardiac Events risk score (GRACE RS) for in-hospital and 1 year mortality across the broad spectrum of non-ST-elevation acute coronary syndromes (ACS) and (ii) to determine their incremental prognostic utility beyond overall risk assessment by physicians. METHODS AND RESULTS: We calculated the TIMI RS, PURSUIT RS, and GRACE RS for 1,728 patients with non-ST-elevation ACS in the prospective, multicentre, Canadian ACS II Registry. Discriminatory performance was measured by the c-statistic (area under receiver-operating characteristic curve) and compared by the method described by DeLong. TIMI RS, PURSUIT RS, and GRACE RS all demonstrated good discrimination for in-hospital death (c-statistics = 0.68, 0.80, 0.81, respectively, all P < 0.001) and 1 year mortality (c-statistics = 0.69, 0.77, 0.79, respectively, all P < 0.0001). However, PURSUIT RS and GRACE RS performed significantly better than the TIMI RS in predicting in-hospital (P = 0.036 and 0.02, respectively) and 1 year (P = 0.006 and 0.001, respectively) outcomes. In multivariable analysis adjusting for the use of in-hospital revascularization, stratification by tertiles of risk scores (into low, intermediate, and high-risk groups) furnished independent and greater prognostic information compared with risk assessment by treating physicians for 1 year outcome. CONCLUSION: Compared with TIMI RS, both PURSUIT RS and GRACE RS allow better discrimination for in-hospital and 1 year mortality in patients presenting with a wide range of ACS. All three risk scores confer additional important prognostic value beyond global risk assessment by physicians. These validated risk scores may refine risk stratification, thereby improving patient care in routine clinical practice. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/17437970/Risk_scores_for_risk_stratification_in_acute_coronary_syndromes:_useful_but_simpler_is_not_necessarily_better_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehm004 DB - PRIME DP - Unbound Medicine ER -