[Prognostic value of GRACE scores versus TIMI score in acute coronary syndromes].
BACKGROUND
Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation.


OBJECTIVE
To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS.


METHODS
Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study.


RESULTS
A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores.


CONCLUSIONS
Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.
Correia
Luis C L
LC
Escola Bahiana de Medicina, Salvador, BA, Brasil. lccorreia@cardiol.br
Freitas
Rafael
R
Bittencourt
Ana P
AP
Souza
Alexandre C
AC
Almeida
Maria C
MC
Leal
Jamile
J
Esteves
José Péricles
JP
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods / Q000592:standards