European Heart Journal Advance Access published online on March 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi187
1 Cardiology Department, Santa Cruz Hospital, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
* To whom correspondence should be addressed. Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63 ± 11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672-0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584-0.674), and TIMI RS (AUC: 0.585; CI: 0.539-0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. Conclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.
Received November 21, 2004
Revised January 24, 2005
Accepted January 27, 2005
Clinical research
TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTEACS
Pedro de Araújo Gonçalves, E-mail: paraujogoncalves{at}yahoo.co.uk
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D S C Ang, L Wei, M P C Kao, C C Lang, and A D Struthers A comparison between B-type natriuretic peptide, Global Registry of Acute Coronary Events (GRACE) score and their combination in ACS risk stratification Heart, November 15, 2009; 95(22): 1836 - 1842. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Alberts, D. L. Bhatt, J.-L. Mas, E. M. Ohman, A. T. Hirsch, J. Rother, G. Salette, S. Goto, S. C. Smith Jr, C.-S. Liau, et al. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry Eur. Heart J., October 1, 2009; 30(19): 2318 - 2326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. M. Kronish, N. Rieckmann, J. E. Schwartz, D. R. Schwartz, and K. W. Davidson Is Depression After an Acute Coronary Syndrome Simply a Marker of Known Prognostic Factors for Mortality? Psychosom Med, September 1, 2009; 71(7): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Steg Heart rate management in coronary artery disease: the CLARIFY registry Eur. Heart J. Suppl., August 1, 2009; 11(suppl_D): D13 - D18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Brieger, K A A Fox, G FitzGerald, K A Eagle, A Budaj, A Avezum, C B Granger, B Costa, F A Anderson Jr, P. G Steg, et al. Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events Heart, June 1, 2009; 95(11): 888 - 894. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. D. Hillis and R. A. Lange Optimal Management of Acute Coronary Syndromes N. Engl. J. Med., May 21, 2009; 360(21): 2237 - 2240. [Full Text] [PDF]
|
|
|
|
|
|
K. S. Woo Perusal of risk stratification of acute myocardial infarction for half a century Eur. Heart J., May 1, 2009; 30(9): 1030 - 1032. [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Yan, R. T. Yan, T. Huynh, A. Casanova, F. E. Raimondo, D. H. Fitchett, A. Langer, S. G. Goodman, and for the Canadian Acute Coronary Syndrome Registry Understanding Physicians' Risk Stratification of Acute Coronary Syndromes: Insights From the Canadian ACS 2 Registry Arch Intern Med, February 23, 2009; 169(4): 372 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C P Gale, S O M Manda, C F Weston, J S Birkhead, P D Batin, and A S Hall Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database Heart, February 1, 2009; 95(3): 221 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. W. Hamm, H. Möllmann, J.-P. Bassand, and F. van de Werf CHAPTER 16 Acute Coronary Syndromes ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A L Baggish, D M Lloyd-Jones, J Blatt, A M Richards, J Lainchbury, M O'Donoghue, R Sakhuja, A A Chen, and J L Januzzi A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme Heart, August 1, 2008; 94(8): 1032 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Karounos, A. M. Chang, J. L Robey, K. L Sease, F. S Shofer, C. Follansbee, and J. E Hollander TIMI risk score: does it work equally well in both males and females? Emerg. Med. J., July 1, 2007; 24(7): 471 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
|
|
|
|
|
|
A. T. Yan, R. T. Yan, M. Tan, A. Casanova, M. Labinaz, K. Sridhar, D. H. Fitchett, A. Langer, and S. G. Goodman Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better Eur. Heart J., May 1, 2007; 28(9): 1072 - 1078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Boos, S. K. Soor, D. Kang, and G. Y.H. Lip Relationship between circulating endothelial cells and the predicted risk of cardiovascular events in acute coronary syndromes Eur. Heart J., May 1, 2007; 28(9): 1092 - 1101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Steg, J. Lopez-Sendon, E. Lopez de Sa, S. G. Goodman, J. M. Gore, F. A. Anderson Jr, D. Himbert, J. Allegrone, F. Van de Werf, and for the GRACE Investigators External Validity of Clinical Trials in Acute Myocardial Infarction Arch Intern Med, January 8, 2007; 167(1): 68 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ramsay, M. Podogrodzka, C. McClure, and K.A.A. Fox Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation QJM, January 1, 2007; 100(1): 11 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A A Fox, O. H Dabbous, R. J Goldberg, K. S Pieper, K. A Eagle, F. Van de Werf, A. Avezum, S. G Goodman, M. D Flather, F. A Anderson Jr, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) BMJ, November 25, 2006; 333(7578): 1091 - 1091. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Kereiakes and E. M. Antman Clinical Guidelines and Practice: In Search of the Truth J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1129 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Fifth Organization to Assess Strategies in Acu Comparison of Fondaparinux and Enoxaparin in Acute Coronary Syndromes N. Engl. J. Med., April 6, 2006; 354(14): 1464 - 1476. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The OASIS-6 Trial Group* Effects of Fondaparinux on Mortality and Reinfarction in Patients With Acute ST-Segment Elevation Myocardial Infarction: The OASIS-6 Randomized Trial JAMA, April 5, 2006; 295(13): 1519 - 1530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Tarantini, A. Ramondo, S. Iliceto, D. E. Newby, K. A. Fox, A. Ionescu, A. Garg, C. Spaulding, O. Varenne, S. Weber, et al. Management of Acute Coronary Syndromes N. Engl. J. Med., December 22, 2005; 353(25): 2714 - 2718. [Full Text] [PDF]
|
|
|
|
|
|
C.-K. Wong and H. D. White Value of community-derived risk models for stratifying patients with non-ST elevation acute coronary syndromes Eur. Heart J., May 1, 2005; 26(9): 851 - 852. [Full Text] [PDF]
|
|