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 accuracyAbstract
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.
References
De Winter RJ, Tijssen JGP. Non–ST-Segment Elevation Myocardial Infarction Revascularization for Everyone? J Am CollCardiol 2012;5(9):903-5.
McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011;124(1):40-7.
Barbosa CE, Viana M, Brito M, Sabino M, Garcia G, Maraux M. Accuracy of the GRACE and TIMI scores in predicting the angiographic severity of acute coronary syndrome. Arq Brasil Cardiol 2012;99(3):818-24.
Hamm CW, Bassand J-P, Agewall S, Bax J, Boersma E, Bueno H. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2015;32(23):2999-3054.
Isilak Z, Kardesoglu E, Aparci M, Uz O, Yalcin M, Yiginer O. Comparison of clinical risk assessment systems in predicting three-vessel coronary artery disease and angiographic culprit lesion in patients with non-ST segment elevated myocardial infarction/unstable angina pectoris. Kardiol Pol 2012;70(3):242-50.
Bekler A, Altun B, Gazi E, Temiz A, Barutçu A, Güngör Ö. Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome. Anadolu Kardiyol Derg 2014;14:1-6.
El-Sayed, M., Aly, A., Abotaleb, A., Gaafar, A., Sarhan, M., Elbokary, A., Osman, M. Correlation between Thrombolysis in Myocardial Infarction and The Global Registry of Acute Coronary Syndromes Risk Scores and Severity of Coronary Artery Disease in Patients with Non-ST Elevation Acute Coronary Syndrome. The Egyptian Journal of Hospital Medicine, 2019; 75(4): 2639-2645. doi: 10.12816/ejhm.2019.31453.
Terkelsen CJ1, Lassen JF, Nørgaard BL et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutaneous coronary intervention. Eur Heart J,2005, 26(8):770-7.
Akhter Z, Rind IA, Aijaz S, Sattar S, Malik R, Pathan A. Management, hospital outcome and revascularization trends in non-ST elevation myocardial infarction with high GRACE risk score. JPMA. The Journal of the Pakistan Medical Association. 2019 Oct 1;69(10):1486.
Nakachi T, Kosuge M, Hibi K, Ebina T, Tsukahara K, Okuda J. Comparison of GRACE risk score versus TIMI risk score on angiographic findings in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2010; 55: A115-E1071.
Khalill R, Han L, Jing C, et al. The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients. Exp Clin Cardiol 2009;14:e25–30.
