Prospective comparison of the 5 most popular risk scores in clinical use for unselected patients with acute coronary syndrome.
BACKGROUND
A limited number of studies comparing the main risk scores (RS) for acute coronary syndromes (ACS) have been conducted and there is a limited number of long-term observations of unselected patient cohorts evaluated with the various RS. The aim of this study was to validate 5 RS (TIMI STEMI RS, TIMI NSTEMI/UA RS, GRACE RS, SIMPLE RS and ZWOLLE RS) in a Polish population and to develop a new RS that would specifically predict 1-year mortality in the unselected ACS patient cohort.


RESULTS
Single-center ACS registry analysis with 1-year follow-up of 931 patients and prospective comparison of 5 RS was conducted. Creation of an RS was attempted. Risk factors were evaluated in a multivariate logistic regression model. The predictive value of the model was assessed with evaluation of the area under curve (AUC) in receiver-operating characteristic analysis. Twelve independent factors influencing 1-year mortality were identified and of them, clerking, physical findings on admission, first ECG and myocardial necrosis markers demonstrated sufficiently high predictive value. All 5 RS were successfully validated in the target registry and although they all displayed high predictive value, the TIMI RS STEMI (AUC = 0.84) and GRACE RS (AUC = 0.84) proved superior.


CONCLUSIONS
The developed Banach score offers both high goodness-of-fit and predictive value and may be used irrespective of ACS type.
1st Chair and Department of Cardiology, Central University Hospital, Medical University of Warsaw, Warsaw, Poland. krzysztof.flipiak@wum.edu.pl
Krzysztof J
KJ
Filipiak
Lukasz
L
Koltowski
Marcin
M
Grabowski
Grzegorz
G
Karpinski
Renata
R
Glowczynska
Zenon
Z
Huczek
Janusz
J
Kochman
Franciszek
F
Majstrak
Grzegorz
G
Opolski
D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016009:Chi-Square Distribution; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult