Accuracy of dedicated risk scores in patients undergoing primary percutaneous coronary intervention in daily clinical practice.

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. 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. 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). 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.

Abelin AP ，David RB ，Gottschall CA ，Quadros AS ... -  《-》

Comparison of the prognostic predictive value of the TIMI, PAMI, CADILLAC, and GRACE risk scores in STEACS undergoing primary or rescue PCI.

We sought to compare the predictive value of the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) scores for the outcome of ST-segment elevation acute coronary syndrome undergoing urgent percutaneous coronary intervention. We performed a retrospective analysis of a cohort composed of all consecutive patients with ST-segment elevation acute coronary syndrome treated by urgent percutaneous coronary intervention between 2006 and 2010 (n=1503). TIMI, PAMI, CADILLAC, and GRACE risk scores were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for death, reinfarction, and target-vessel revascularization at 30 days and 1 year, using the C statistic, which was obtained by means of logistic regression and ROC curves. The TIMI, PAMI, CADILLAC and GRACE showed an excellent predictive value for 30-day and 1-year mortality (C statistic range, 0.8-0.9), with superiority of the TIMI, CADILLAC, and GRACE risk models. The performance of these 4 scores was poor for both reinfarction and target-vessel revascularization (C statistic, 0.5-0.6). The TIMI, PAMI, CADILLAC, and GRACE scores provide excellent information to stratify the risk of mortality in patients treated by percutaneous coronary intervention. The TIMI, CADILLAC, and GRACE models have higher predictive accuracy. The usefulness of these models for reinfarction and target-vessel revascularization prediction is questionable.

Méndez-Eirín E ，Flores-Ríos X ，García-López F ，Pérez-Pérez AJ ，Estévez-Loureiro R ，Piñón-Esteban P ，Aldama-López G ，Salgado-Fernández J ，Calviño-Santos RA ，Vázquez Rodríguez JM ，Vázquez-González N ，Castro-Beiras A ... -  《-》

Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

Lev EI ，Kornowski R ，Vaknin-Assa H ，Porter A ，Teplitsky I ，Ben-Dor I ，Brosh D ，Fuchs S ，Battler A ，Assali A ... -  《AMERICAN JOURNAL OF CARDIOLOGY》

GRACE, TIMI, Zwolle and CADILLAC risk scores--do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively?

GRACE, TIMI, Zwolle, and CADILLAC are risk scores designed for predicting short-term outcome after acute coronary syndromes. The aim of our study was to test their utility for a prognosis of 5-year survival in a "real-life" population of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (pPCI). Our registry consisted of consecutive patients with STEMI treated with pPCI. Five-year follow-up was performed with all-cause mortality as the end-point. Out of 505 patients (mean age 58.6±11.3 years) 32 died during the first 30 days (6.3%) and an additional 74 within 5 years (15.6%). PCI was successful in 95.2% (n=481). Prognostic values (c statistics) for predicting 5-year mortality equaled: 0.742 (CI 0.69-0.79) for the GRACE risk score, 0.727 (CI 0.67-0.78) for TIMI, 0.72 (CI 0.67-0.77) for Zwolle, and 0.687 (CI 0.63-0.74) for CADILLAC. In a univariate analysis all the scores were associated with the 5-year outcome. GRACE, TIMI, and Zwolle risk scores predicted well 5-year all-cause mortality in patients with STEMI treated with pPCI. Our data show that the usefulness of initial bedside risk assessment can be further extended for long-term follow-up.

Kozieradzka A ，Kamiński KA ，Maciorkowska D ，Olszewska M ，Dobrzycki S ，Nowak K ，Kralisz P ，Prokopczuk P ，Musial WJ ... -  《-》

Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

Brkovic V ，Dobric M ，Beleslin B ，Giga V ，Vukcevic V ，Stojkovic S ，Stankovic G ，Nedeljkovic MA ，Orlic D ，Tomasevic M ，Stepanovic J ，Ostojic M ... -  《-》