GRACE vs TIMI Score: Comparing the Prognostic Accuracy for Death or Myocardial Infarction in Non-ST Elevation Acute Coronary Syndrome Patients

The management of non-ST elevation acute coronary syndromes (NSTE-ACS) has become increasingly complex, with multiple scores available to aid in early risk stratification on admission. The GRACE and TIMI risk scores are two such scores that have been widely used to predict the prognosis of patients with NSTE-ACS. This article aims to compare the prognostic accuracy of these two scores for death or myocardial infarction (MI) at one year in patients with non-ST elevation acute coronary syndromes.

The GRACE and TIMI risk scores were calculated using specific variables collected at admission, including clinical history, ECG, and laboratory tests. The high-risk patients represented 36.7%, 28.7%, and 57.8% of the population for the GRACE, PURSUIT, and TIMI RSs, respectively.

The results showed that the GRACE risk score had the best predictive accuracy for death or MI at one year (AUC: 0.630 CI: 0.584–0.674), followed closely by the PURSUIT risk score (AUC: 0.630 CI: 0.584–0.674) and the TIMI risk score (AUC: 0.585 CI: 0.539–0.631). The best cut-off value for each RS, calculated using receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI.

The study 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 high-risk patients. The results suggest that early risk stratification at admission is essential for a tailored therapeutic strategy in patients with non-ST elevation acute coronary syndromes.

In conclusion, the GRACE and TIMI risk scores are valuable tools for predicting death or MI at one year in patients with non-ST elevation acute coronary syndromes. The study highlights the importance of early risk stratification on admission to identify high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

Overall, this study demonstrates that the GRACE and TIMI scores have similar predictive accuracy for death or MI at one year in patients with non-ST elevation acute coronary syndromes. The results suggest that these scores can be used to identify high-risk patients who will benefit from early revascularization, reducing the risk of adverse clinical events and improving patient outcomes.

Grace vs timi score