Prognostic value of GRACE versus TIMI Score for in-hospital outcomes after non-ST-Elevation acute coronary syndrome

Type of funding sources: None.

The risk stratification scores are very helpful to categorize high risk patients to plan future management. Therefore, in this study we compared the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS).

This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center in Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores.

A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04 ± 10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19 ± 33.17 and 3.18 ± 0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cutoff value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cutoff value of 4 with sensitivity of 75.0% and specificity of 67.6%.

The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.