Accuracy of dedicated risk scores in patients undergoing primary percutaneous coronary intervention in daily clinical practice.
BACKGROUND
Comparisons between dedicated risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in real-world clinical practice are scarce. The aim of this study was to assess the diagnostic performance of the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores in STEMI patients undergoing pPCI in contemporary clinical practice.


METHODS
This was a prospective cohort study of consecutive patients with STEMI undergoing pPCI between December 2009 and November 2010 in a high-volume tertiary referral centre. The outcomes assessed were major cardiovascular events (MACEs) and death within 30 days. The diagnostic accuracy of the scores was assessed using receiver operating characteristic curves, and scores were compared using the DeLong method.


RESULTS
During the study period, 501 patients were included. Within 30 days, 62 patients (12.4%) presented a MACE and 39 individuals (7.8%) died. All scores were statistically associated with death and MACE within 30 days (P < 0.01). The c-statistic and 95% confidence intervals for 30-day mortality were: GRACE, 0.84 (0.78-0.90); TIMI, 0.81 (0.74-0.87); Zwolle, 0.80 (0.73-0.87); and PAMI, 0.75 (0.68-0.82) (P < 0.01). There was no statistically significant difference regarding the accuracy of the TIMI, GRACE, and Zwolle scores for 30-day mortality, but the GRACE score was superior to the PAMI score (P < 0.01).


CONCLUSIONS
The TIMI, GRACE, and Zwolle scores performed equally well as predictors of mortality in patients who underwent pPCI in current practice. These results suggest that these scores are suitable options for risk assessment in a real-world setting.
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Programa de Pós Graduação em Ciências da Saúde: Cardiologia, Porto Alegre, Brazil.
Anibal P
AP
Abelin
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Programa de Pós Graduação em Ciências da Saúde: Cardiologia, Porto Alegre, Brazil.
Renato B
RB
David
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Programa de Pós Graduação em Ciências da Saúde: Cardiologia, Porto Alegre, Brazil.
Carlos A
CA
Gottschall
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Programa de Pós Graduação em Ciências da Saúde: Cardiologia, Porto Alegre, Brazil. Electronic address: alesq@terra.com.br.
Alexandre S
AS
Quadros
D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome