Precisely accurate or accurately precise: Diagnostic accuracy of GRACE and TIMI scoring system for prediction of triple vessel coronary artery disease in patients presenting with non-ST elevation myocardial infarction taking angiography as gold standard
Keywords:Triple vessel coronary artery disease, non-ST elevation myocardial infarction, GRACE and TIMI scoring system, diagnostic accuracy
Patients with acute coronary syndrome can present with ST-segment elevation myocardial infarction (STEMI), non–STEMI (NSTEMI) or unstable angina. Varying degree of reduction in coronary blood flow is observed on coronary angiography in patients with non–STEMI (NSTEMI). In patients with acute coronary syndrome reported frequency of NSEMI is 61.5%. It is essential to stratify risk for adequate clinical decision making and to individualize patients who can benefit from invasive treatment strategy.
AIMS & OBJECTIVE: To determine the diagnostic accuracy of GRACE and TIMI scoring system for prediction of triple vessel coronary artery disease in patients presenting with non-ST elevation myocardial infarction (STEMI) taking angiography as gold standard.
MATERIALS AND METHODS: A single centered, prospective, analytical cross sectional trial conducted from March 2018, to Feb 2019. 290 patients were included in the study after fulfilling inclusion criteria. Patients wereassessed for TIMI and GRACE risk scores and were labeled as positive and negative for both methods. Coronary angiography was carried out for detection of triple vessel coronary artery disease. All the information was observed and recorded.
RESULTS: A total number of 290 patients with NSTEMI were studied. Frequency of triple vessel coronary artery disease was 25.17%. The diagnostic accuracy of GRACE scoring system was 76.71%, 60.37%, 39.43%, 88.51%, 64.48% for sensitivity, specificity followed by positive and negative predictive values, and diagnostic accuracy of TIMI scoring system was 58.90%, 86.64%, 59.72%, 86.24%, 79.65% while angiography considered as gold standard.
CONCLUSION: The diagnostic accuracy of GRACE is significantly better than TIMI scoring system for prediction of triple vessel disease in patients presenting with NSTEMI.
KEY WORDS: Triple vessel coronary artery disease, non-ST elevation myocardial infarction, GRACE and TIMI scoring system, diagnostic accuracy.
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