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Accuracy of dedicated risk scores in patients undergoing primary percutaneous coronary intervention in daily clinical
Anibal P Abelin1, Renato B David1, Carlos A Gottschall1
1Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Programa de Pós Graduação em Ciências da Saúde: Cardiologia, Porto Alegre, Brazil.
Insights
The Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle risk scores accurately predict mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). These scores are suitable for real-world risk assessment.
Area of Science:
- Cardiology
- Clinical Medicine
- Interventional Cardiology
Background:
- Risk stratification is crucial for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
- Limited real-world comparisons exist for dedicated risk scores in this population.
- This study evaluates the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores.
Purpose of the Study:
- To compare the diagnostic performance of four established risk scores.
- To assess the accuracy of GRACE, PAMI, TIMI, and Zwolle scores in predicting 30-day mortality and major adverse cardiovascular events (MACE) in STEMI patients undergoing pPCI.
- To provide evidence for optimal risk assessment in contemporary clinical practice.
Main Methods:
- Prospective cohort study including 501 consecutive STEMI patients undergoing pPCI.
- Assessment of 30-day mortality and MACE as primary outcomes.
- Diagnostic accuracy evaluated using receiver operating characteristic (ROC) curves and compared via the DeLong method.
Main Results:
- All evaluated scores (GRACE, PAMI, TIMI, Zwolle) were significantly associated with 30-day mortality and MACE.
- The GRACE score demonstrated the highest predictive accuracy for 30-day mortality (c-statistic: 0.84).
- TIMI, GRACE, and Zwolle scores showed comparable accuracy, outperforming the PAMI score for mortality prediction.
Conclusions:
- TIMI, GRACE, and Zwolle risk scores exhibit similar and effective performance in predicting mortality for STEMI patients undergoing pPCI.
- These scores are validated for use in real-world clinical settings for risk stratification.
- The findings support the continued use of these scores in guiding patient management and treatment decisions.
Background:
Comparisons between dedicated risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in real-world clinical practice are scarce. The aim of this study was to assess the diagnostic performance of the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores in STEMI patients undergoing pPCI in contemporary clinical practice.
Methods:
This was a prospective cohort study of consecutive patients with STEMI undergoing pPCI between December 2009 and November 2010 in a high-volume tertiary referral centre. The outcomes assessed were major cardiovascular events (MACEs) and death within 30 days. The diagnostic accuracy of the scores was assessed using receiver operating characteristic curves, and scores were compared using the DeLong method.
Results:
During the study period, 501 patients were included. Within 30 days, 62 patients (12.4%) presented a MACE and 39 individuals (7.8%) died. All scores were statistically associated with death and MACE within 30 days (P < 0.01). The c-statistic and 95% confidence intervals for 30-day mortality were: GRACE, 0.84 (0.78-0.90); TIMI, 0.81 (0.74-0.87); Zwolle, 0.80 (0.73-0.87); and PAMI, 0.75 (0.68-0.82) (P < 0.01). There was no statistically significant difference regarding the accuracy of the TIMI, GRACE, and Zwolle scores for 30-day mortality, but the GRACE score was superior to the PAMI score (P < 0.01).
Conclusions:
The TIMI, GRACE, and Zwolle scores performed equally well as predictors of mortality in patients who underwent pPCI in current practice. These results suggest that these scores are suitable options for risk assessment in a real-world setting.
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