GRACE and TIMI are the two most popular prediction models in ACS developed during the prereperfusion era and have been compared face to face mainly in the Caucasian population. Therefore, there is an essential need to assess individual risk easily and accurately. Guidelines recommend that high-risk patients receive more aggressive invasive treatment upon risk stratification on admission. Risk assessment was crucial in guiding therapeutic decision-making. However, NSTEMI patients have a large range of clinical consequences, from minimal sequelae to early death. A major component of ACS, Non-ST segment elevation myocardial infarction (NSTEMI), has more than twice the incidence compared to ST-segment elevation myocardial infarction (STEMI). The prevalence of acute coronary syndromes (ACS) has increased significantly during the recent 30 years in China. The sequential use of TIMI and GRACE scores provide an easy and promising discriminative tool in predicting outcomes in NSTEMI East Asian patients.Ĭardiovascular disease remains the main contributor to the cause of death globally. GRACE showed better predictive accuracy than TIMI in East Asian NSTEMI patients in both in-hospital and long-term outcomes. Combined use of the two risk scores reserved both the convenience of scoring and the predictive accuracy. 0.68 long-term cardiac mortality: 0.91 vs. GRACE risk scores showed a better predictive ability than TIMI risk scores both for in-hospital and long-term outcomes. Compared to TIMI medium group + GRACE < 140 subgroup, the TIMI medium + GRACE high-risk (≥ 140) subgroup had a significantly higher in-hospital events (39.5% vs. Further subgrouping the TIMI medium group showed that half (53.5%) of the TIMI medium risk population was GRACE high risk (≥ 140). GRACE score grouped most patients (45.7%) into high risk, while TIMI grouped the majority (61.2%) into medium risk. ResultsĪ total of 232 patients were included (female 29.7%, median age 67 years), with a median follow-up of 3.7 years. Long-term outcomes were all-cause mortality and cardiac mortality in 4-year follow-up. In-hospital endpoints were defined as the in-hospital composite event, including mortality, re-infarction, heart failure, stroke, cardiac shock, or resuscitation. Patients were scored by TIMI and GRACE scores on hospital admission. This retrospective observational study consecutively collected patients in a large academic hospital between 01/01 and and followed for 4 years. Limited study compared two risk scores, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores in the current East Asian NSTEMI patients. The TIMI risk score is valid and can be used for risk stratification of STEMI patients for better targeted treatment.Risk stratification in non-ST segment elevation myocardial infarction (NSTEMI) determines the intervention time. Calibration was good for the overall study population and diabetics, with χ2 goodness of fit test p value of 0.936 and 0.983 respectively, but poor for those with renal impairment, χ2 goodness of fit test p value of 0.006. Discrimination was good for the overall study population (c statistic 0.785) and in the high risk subgroups diabetics (c statistic 0.764) and renal impairment (c statistic 0.761). The TIMI risk score was strongly associated with 30-day mortality. Model discrimination and calibration was tested in the overall population and in subgroups of patients that were at higher risk of mortality i.e., diabetics and those with renal impairment.Ĭompared to the TIMI population, this study population was younger, had more chronic conditions, more severe index events and received treatment later. The TIMI risk score was evaluated in 4701 patients who presented with STEMI. This study sought to validate the Thrombolysis In Myocardial Infarction (TIMI) risk score for STEMI in a multi-ethnic developing country.ĭata from a national, prospective, observational registry of acute coronary syndromes was used. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases. Risk stratification in ST-elevation myocardial infarction (STEMI) is important, such that the most resource intensive strategy is used to achieve the greatest clinical benefit.
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