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The Value of Different Short-Term Risk Scoring Models in Predicting Long-Term Death of Acute Myocardial Infarction
Bosen Yang1, Lin Bai1, Yike Zhang1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Insights
The GRACE score accurately predicts long-term mortality in acute myocardial infarction (AMI) patients, outperforming TIMI and HEART scores. This cardiovascular risk assessment tool offers superior prognostic value for patient outcomes.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Public Health
Background:
- Acute myocardial infarction (AMI) necessitates reliable prognostic tools for long-term patient management.
- Existing short-term cardiovascular risk scores require evaluation for their long-term predictive accuracy in AMI.
- GRACE, TIMI, and HEART scores are commonly used but their comparative long-term efficacy is not fully established.
Purpose of the Study:
- To compare the long-term prognostic value of the GRACE, TIMI, and HEART risk scoring models in patients diagnosed with acute myocardial infarction.
- To assess the ability of these scores to predict all-cause mortality and stratify risk over an extended follow-up period.
Main Methods:
- Retrospective analysis of 2220 acute myocardial infarction patients hospitalized between 2011-2013.
- Application of GRACE, TIMI, and HEART scores to hospitalization data.
- Long-term follow-up until January 2021, confirming mortality via multiple data sources.
- Comparative analysis using Receiver Operating Characteristic (ROC) curves (AUC) and Kaplan-Meier survival analysis.
Main Results:
- The GRACE score demonstrated significantly higher predictive accuracy (AUC = 0.734) for long-term mortality in both STEMI and NSTEMI patients compared to TIMI (AUC = 0.675 / 0.665) and HEART scores (AUC = 0.632 / 0.611).
- GRACE and TIMI scores effectively stratified patients into different risk categories (p < 0.01).
- The HEART score exhibited poor risk stratification capabilities (p > 0.05).
Conclusions:
- The GRACE risk score is a more accurate tool for assessing long-term mortality risk in acute myocardial infarction patients.
- GRACE score's superior performance suggests its utility in guiding long-term management strategies for AMI.
- Further research is warranted to validate and refine the application of the GRACE score in diverse AMI populations.
Abstract:
Background and aims: To compare the value of three commonly used cardiovascular short-term risk scoring models, the GRACE score, TIMI score, and HEART score, in predicting the long-term prognosis of patients with acute myocardial infarction. Methods: The hospitalization data of patients who were hospitalized in West China Hospital of Sichuan University from 2011 to 2013 and diagnosed with acute myocardial infarction (AMI) were collected. The patients were scored by GRACE score, TIMI score, and HEART score. The long-term follow-up of patients was conducted until the end of January 2021. All-cause death and time of death of patients were confirmed by telephone follow-up, electronic medical record query, and household registration information. The predictive ability of different risk scores for long-term prognosis was compared according to the receiver operating characteristic (ROC) area under the curve (AUC), and the ability to distinguish patients with different risk levels was compared according to Kaplan−Meier survival curves. Results: The study ultimately included 2220 patients, with a median follow-up of 8 years and 454 (20.5%) deaths until the end of follow-up. Whether in ST-segment elevation myocardial infarction (STEMI) patients or non-ST-segment elevation myocardial infarction (NSTEMI) patients, the AUC value of the GRACE score (both AUC = 0.734) was significantly higher than the TIMI score (AUC = 0.675, p < 0.01; AUC = 0.665, p < 0.01) and HEART score (AUC = 0.632, p < 0.01; AUC = 0.611, p < 0.01) until the end of follow-up. In terms of risk stratification, the Kaplan−Meier survival curve shows that both THE GRACE score and TIMI score can distinguish AMI patients with different risk levels (p < 0.01), but the risk stratification ability of the HEART score in AMI patients was poor (p > 0.05). Conclusion: The GRACE risk score could represent a more accurate model to assess long-term death of acute myocardial infarction, but further studies are required.
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