Prognostic value of timi score versus grace score in st. The timi score for stsegment elevation myocardial infarction stemi was created and validated specifically for this clinical scenario, while the grace score is generic to any type of acute coronary syndrome. Grace score calculation was made using an online calculator s. The timi risk score for stemi figure 2 showed a strong association with mortality at 30 days, with a 40fold graded increase in mortality between those with a risk score of 0 and those with a score 8 p trend score 5 identified 12% of patients with a mortality risk 2fold higher than the mean for the population.
Methods pub med was systematically searched for the timi, pursuit and grace risk score studies, especially the uanstemi studies. By using validated risk scores, we can help decrease the risk of missing ami and the resultant adverse events. Timi and grace risk scores predict both shortterm and long. Timi score risk classification showed that among 5029. Timi, grace and alternative risk scores in acute coronary. Predicting 30day major adverse cardiovascular events after primary percutaneous coronary intervention riskpci score was developed to predict 30day mace, such as. This distinguishes the timi risk score from other scoring systems that are more complex computationally since they require weighting terms for the predictor variables and cannot be implemented easily without computer assistance.
Thrombolysis in myocardial infarction timi predicts risk of adverse outcomes in the next 14 days. Timi, pursuit, and grace risk scores oxford academic journals. The timi risk score for unstable anginanonst elevation mi. Also patients not divided into different risk groups also patients not divided into different risk groups frisc. Esc guidelines for the management of acute coronary syndromes. A critical form of cardiovascular disease is acute coronary syndrome acs, which includes heart attack and unstable angina that may lead into heart attack. The grace scores, pursuit scores and timi score were subsequently divided into low, intermediate and high equivalent strata to facilitate comparison. Timi and grace are the risk scores that up until now have been most extensively investigated, with grace performing better. A comparison of the timi, grace and heart scores heart. The percent of patients with 30day mace with heart scores between 0 and 3, 46, and 710 was 2%, 28%, and 63%, respectively. Esc guidelines for the management of acute coronary syndromes in patients presenting without persistent stsegment elevation. The results and analyse of spearman rank showed that timi has p 0,000 r 0. The standard of care for clinical decisionmaking was a.
Although this was a retrospective study, for each patient the original grace and timi scores at admission were recalculated based on their medical records. Accuracy of the timi and grace scores in predicting. Diagnostic accuracy of timi versus grace score for. This study showed that compared with timi score, grace score provides greater diagnostic information with regards to the extent of cad in patients with nsteacs. Global registry of acute coronary events grace predicts outcomes at 6 months. A metaanalysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. The grace score is a prospectively studied scoring system to risk stratifiy patients with diagnosed acs to estimate their inhospital and 6month to 3year mortality. The timi risk score for unstable anginanonst elevation. Risk stratifying chest pain patients in the emergency. Like timi, is simple to use but has a poor predictive power i. Heart outperforms timi, safely identifying more lowrisk patients. The cstatistics predictive value of the timi risk score for mortality was 0. The thrombolysis in myocardial infarction timi risk score, global registry of acute coronary events grace risk index and platelet glycoprotein iibiiia in unstable angina 3. The heart score is sometimes compared to the timi thrombolysis in myocardial infarction and grace global registry of acute coronary events risk scores, which are older acs scores.
Application of the timi risk score for unstable angina and. The timi score identified no low risk patients at this safety level. Timi risk score for stelevation myocardial infarction. The heart score outperformed the grace and timi scores in. The more recent global registry of acute coronary events grace score was developed from the registry, 8 with a population of patients across the entire spectrum of acs. Like the timi score, it was not designed to assess which patients anginal symptoms are due to acs. A meta analysis of 40 derivation studies on 216,552 patients and of 42 validation studies. Use of the timi score to risk stratify acute coronary syndrome patients. Pdf grace risk score vs timi risk score researchgate. The heart score outperformed the grace and timi scores in discriminating between those with and without mace in chest pain patients, and. Although the timi score is the one most frequently used in acute coronary syndromes acs without stsegment elevation, the grace score has potential prognostic superiority, as it was created. The timi risk score may be a useful tool for risk strati. Grace score bleeding risk crusade score take home messages continued 1. A timi risk score of 0 or 1 does not equal zero risk of adverse outcome.
Derived4 from the timi 11b study,5 the score is additive without weighting 07. A timi score timi score in general, patients having multiple coronary risk factors. Interestingly, the shortterm, inhospital risk score such as timi score is also useful in risk stratification for a longterm outcome. Grace comes from the global registry of acute coronary events, an international acs database and is calculated at hospital admission and at. Timi, grace and alternative risk scores in acute coronary syndromes. Does simplicity compromise accuracy in acs risk prediction. Comparison of the grace, heart and timi score to predict major. Performance of the scores was compared by calculating auc curves. Grace, pursuit, and timi scores in risk stratification of chest pain pts prospective data collection for timi score. Esc guidelines for the management of acute coronary. The grace and timi scores correlate moderately with the extent of coronary disease assessed by the syntax score.
Comparison of riskpci, grace, 1 timi risk scores for. Type 2 mi t2mi is common and is associated with significant mortality, yet the. The primary hypothesis of the study is that the heart score is a significantly better predictor than the timi andor grace. Pdf comparing heart, timi, and grace scores for prediction of. Application of the grace, timi, and tarraco risk scores in.
The timi risk score is a tool that doctors use to predict the chances of having or dying from a heart event. To assess the hypothesis that the grace and timi risk scores satisfactorily. The grace and timi score were calculated based on prospectively collected data. The heart, timi, and grace scores have been applied in the emergency department ed to risk stratify patients with undifferentiated. Predictors of hospital mortality in the global registry of acute coronary events. Grace global registry of acute coronary events for both the discharge diagnosis and the occurrence of major adverse cardiovascular events mace is calculated. All these scores were developed for shortterm prognosis. Application of the timi risk score for unstable angina and nonst elevation. Are we missing acute mis with clinical risk scores. Read comparison of the heart, timi and grace risk scores for chest pain patients at the emergency room, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. The grace risk score has made an invaluable contribution to the evaluation of treatment outcomes and patient care. Conclusion the heart score out performs grace and timi in predicting mace in patients presenting to the ed with cardiac sounding chest pain. This grace risk score calculator estimates mortality risk within 6 months to 3 years of myocardial infarction in patients with acute coronary syndrome. There were 10562% patients who had two vessel coronary artery disease.
You can read more about the scoring system, the variables used and the result interpretation below the form. Accuracy of the timi and grace scores in predicting coronary. In patients with uanstemi, the timi risk score is a simple prognostication scheme that categorizes a patients risk of death and ischemic events and provides a basis for therapeutic decision making. The grace and timi scores have been well validated for assessment of prognosis in nonstelevation acute coronary syndrome. The grace risk score stratifies mortality risk 6 mo 3 y from myocardial infarction st elevation and nonst elevation in patients suffering from acute coronary syndrome. The thrombolysis in myocardial infarction timi risk score for stemi was created as the simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis in the intravenous npa for treatment of infarcting myocardium early ii. For nonstsegment elevation myocardial infarction nstemi, the timi score is based on seven clinical indicators with scores ranging from 0 to 7. A comparison of the timi, grace and heart scores full. The accuracy of the grace and timi scores in predicting coronary disease extension in patients with nonstelevation acute coronary syndromes acs has not been established. Approach to stemi and nstemi lal c daga1, upendra kaul2, aijaz mansoor 3 1fellow dnb cardiology.
These criteria were developed during early timi trials to define minor and major hemorrhagic episodes in patients of st segment elevation mi stemi treated with a fibrinolytic drug and have. Pdf accuracy of the grace and timi scores in predicting. Assessing heart attack risk and guiding treatment the research cardiovascular disease is the leading cause of death globally. In this study, the timi score is more reliable in predicting mortality in patient with stemi, compare with grace score.
Additionally, the number of lowrisk patients identified by each score were compared at a fixed level of safety of at least 95% or 98% sensitivity. The thrombolysis in myocardial infarction timi bleeding criteria is one of the most frequently used classifications in the cardiovascular trials. Comparison of the grace, heart and timi score to predict. Between timi and grace scores, identify the one of better prognostic performance in patients with stemi. A retrospective analysis of the timi and grace risk scores.
The values of the timi and grace scores followed normal distribution. A prospective cohort evaluation in emergency patients peter reaney, hamish elliott jamie cooper. Pdf timi, grace and alternative risk scores in acute coronary. In high acuity chest pain patients, the heart score is superior to the timi and grace scores in predicting 30day mace. Comparing performance of grace, heart and timi scores in predicting acs conclusion. The global registry of acute coronary events grace and thrombolysis in myocardial infarction timi risk scores are validated to predict risk of adverse outcomes among patients with type 1 myocardial infarction mi. Very complex to use and a large portion of the score is dependent on the patient age.
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