Comparing TIMI, HEART, and GRACE Risk Scores to Predict Angiographic Severity of Coronary Artery Disease and 30-Day
Necmiye Yalcin Ocak1, Murat Yesilaras2, Baris Kilicaslan3
1Emergency Physician, Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
Insights
The HEART and GRACE risk scores better predict major adverse cardiac events (MACE) in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients than the TIMI score. HEART scores are most reliable for excluding NSTEACS in low-risk individuals.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Risk Stratification
Background:
- Acute coronary syndromes (ACS) present broadly, complicating diagnosis.
- Early risk stratification is crucial for optimal patient care in ACS.
- This study evaluates risk scores for non-ST-segment elevation ACS (NSTEACS) in the emergency department (ED).
Purpose of the Study:
- To assess the predictive accuracy of TIMI, HEART, and GRACE risk scores for major adverse cardiac events (MACE) in NSTEACS patients.
- To evaluate the ability of these risk scores to predict the severity of coronary artery disease (CAD).
- To identify independent predictors of MACE in NSTEACS.
Main Methods:
- Prospective, observational, single-center study of 357 NSTEACS patients.
- Calculation of TIMI, HEART, and GRACE risk scores using recorded patient data.
- Coronary angiograms were evaluated to determine the Gensini score for CAD severity.
Main Results:
- The 30-day MACE rate was 25.5%.
- HEART and GRACE scores demonstrated better MACE prediction than TIMI.
- Age, Mean Arterial Pressure (MAP), and High-Sensitive Troponin I were significant predictors of MACE.
Conclusions:
- GRACE, HEART, and TIMI risk scores show similar ability to predict severe CAD in NSTEACS.
- HEART and GRACE scores are superior to TIMI for predicting MACE in NSTEACS.
- The HEART score is the most reliable for ruling out NSTEACS in low-risk patients.
Background:
Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined.
Methods:
This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients' demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score.
Results:
The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant.
Conclusion:
The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.
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