Comparison of ischemic and bleeding risk scores in non-ST elevation acute coronary syndromes
Pedro Amador1, Jose Ferreira Santos, Sara Gonçalves
1Centro Hospitalar de Setúbal, Cardiologia, Setubal, Portugal. pmcamador@hotmail.com
Insights
Risk scores like TIMI, GRACE, and CRUSADE can predict in-hospital bleeding, recurrent ischemia, and death in non-ST elevation acute coronary syndromes (NSTE-ACS) patients. GRACE and CRUSADE scores showed better prediction for in-hospital death compared to TIMI.
Area of Science:
- Cardiology
- Clinical Risk Stratification
Background:
- Non-ST elevation acute coronary syndromes (NSTE-ACS) represent a spectrum of acute myocardial infarction.
- Accurate risk stratification is crucial for guiding treatment decisions and improving patient outcomes.
Purpose of the Study:
- To compare the discriminatory performance of established ischemic and bleeding risk scores in predicting in-hospital adverse events within the NSTE-ACS population.
- To evaluate the effectiveness of TIMI, GRACE, and CRUSADE risk scores for major bleeding, recurrent ischemia, and death.
Main Methods:
- A single-center study included 516 consecutive NSTE-ACS patients.
- TIMI, GRACE, and CRUSADE risk scores were calculated for each patient.
- In-hospital endpoints included major bleeding, recurrent ischemia (re-infarction or angina), and death, assessed using the c-statistic.
Main Results:
- All three risk scores (TIMI, GRACE, CRUSADE) showed fair discriminatory accuracy for major bleeding.
- GRACE and CRUSADE risk scores significantly outperformed TIMI risk score in predicting in-hospital death.
- No significant difference was observed between the scores for the combined endpoint of in-hospital death or recurrent ischemia.
Conclusions:
- Both ischemic (TIMI, GRACE) and bleeding (CRUSADE) risk scores demonstrate utility in predicting adverse in-hospital events in NSTE-ACS.
- GRACE and CRUSADE scores appear more robust for predicting mortality in this patient cohort.
Objectives:
Compare the discriminatory performance of two validated ischemic risk scores and a bleeding risk score for in-hospital adverse events across the spectrum of non-ST elevation acute coronary syndromes (NSTE-ACS).
Material And Methods:
Single center, 516 consecutive patients admitted with the diagnosis of NSTE-ACS. The following risk scores were calculated for each patient: TIMI, GRACE and CRUSADE. The following in-hospital endpoints were used: major bleeding (as defined by the CRUSADE criteria); recurrent ischemia (re-infarction or recurrent angina); and death. Discriminatory performance was measured by the c-statistic and compared.
Results:
There were 36 major bleeding events, 34 recurrent ischemic events and 10 deaths. TIMI RS, GRACE RS, and CRUSADE RS demonstrated fair discriminatory accuracy for major bleeding (c-statistic = 0.64, 0.58, and 0.61, respectively). GRACE and CRUSADE risk scores demonstrated a better performance than TIMI RS for predicting in-hospital death (c-statistic = 0.92 and 0.86, respectively versus c-statistic = 0.63, P < 0.001). For the combined endpoint of in-hospital death or recurrent ischemia there was no statistically significant difference between CRUSADE RS, GRACE RS, and TIMI RS (c-statistic = 0.58, 0.57, and 0.62, respectively).
Conclusion:
Both ischemic and bleeding risk scores are able to predict in-hospital bleeding, ischemic and fatal events.
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