ABSTRACT
FUNDAMENTO: Embora o Escore de Risco TIMI seja o mais utilizado em síndromes coronarianas agudas sem supradesnível do segmento ST (SCA), o Escore GRACE tem potencial superioridade prognóstica, pois foi criado a partir de um registro observacional, parte das variáveis são tratadas de forma semiquantitativa e a função renal é computada em seu cálculo. OBJETIVO: Testar a hipótese de que o Escore de Risco GRACE tem superior valor prognóstico hospitalar, comparado ao Escore TIMI em pacientes admitidos com SCA. MÉTODOS: Foram incluídos indivíduos com angina instável ou infarto do miocárdio sem supradesnível do segmento ST, consecutivamente internados em unidade coronariana entre agosto de 2007 e janeiro de 2009. RESULTADOS: Foram estudados 154 pacientes, idade 71 ± 13 anos, 56 por cento do gênero feminino, mediana do GRACE de 117 e mediana do TIMI de 3. Durante o período de internamento, a incidência de eventos foi 8,4 por cento (12 óbitos e 1 infarto não fatal). O teste de Hosmer-Lemeshow aplicado ao Escore GRACE apresentou χ2 de 5,3 (P = 0,72), enquanto Escore TIMI apresentou χ2 de 1,85 (P = 0,60). Desta forma, ambos os escores apresentaram boa calibração. Quanto à análise de discriminação, o Escore GRACE apresentou estatística-C de 0,91 (95 por cento IC = 0,86 - 0,97), significativamente superior à estatística-C de 0,69 do Escore TIMI (95 por cento IC = 0,55 - 0,84) - P = 0,02 para diferença entre os escores. CONCLUSÃO: Em relação à predição de eventos hospitalares em pacientes com SCA, o Escore GRACE tem superior capacidade prognóstica quando comparado ao Escore TIMI.
BACKGROUND: Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE: To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS: Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS: A total of 154 patients aged 71 ± 13 years, of which 56 percent were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4 percent (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an χ2 of 5.3 (P = 0.72), whereas the TIMI score presented an χ2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95 percentCI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95 percentCI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION: Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.
Subject(s)
Aged , Female , Humans , Male , Acute Coronary Syndrome , Echocardiography/methods , Hospitalization/statistics & numerical data , Acute Coronary Syndrome/mortality , Angina, Unstable/mortality , Angina, Unstable , Echocardiography/standards , Myocardial Infarction/mortality , Myocardial Infarction , Prognosis , ROC Curve , Risk Assessment/methods , Risk Assessment/standardsABSTRACT
BACKGROUND: Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE: To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS: Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS: A total of 154 patients aged 71 +/- 13 years, of which 56% were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4% (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an chi2 of 5.3 (P = 0.72), whereas the TIMI score presented an chi2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95%CI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95%CI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION: Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.
Subject(s)
Acute Coronary Syndrome/diagnostic imaging , Echocardiography/methods , Hospitalization/statistics & numerical data , Acute Coronary Syndrome/mortality , Aged , Angina, Unstable/diagnostic imaging , Angina, Unstable/mortality , Echocardiography/standards , Female , Humans , Male , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/mortality , Prognosis , ROC Curve , Risk Assessment/methods , Risk Assessment/standardsABSTRACT
BACKGROUND: Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS. METHODS: Five cytokines (interleukin (IL)-1beta, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-alpha soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS. RESULTS: During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1beta, IL-12, TNF-alpha, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80). CONCLUSION: Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS.
Subject(s)
Acute Coronary Syndrome/blood , Acute Coronary Syndrome/diagnosis , Chemokines/blood , Cytokines/blood , Aged , C-Reactive Protein/analysis , Female , Humans , Male , Predictive Value of Tests , PrognosisABSTRACT
BACKGROUND: It is not known in what extent admission glucose improves risk stratification of the GRACE Score in patients with non-ST-segment elevation acute coronary syndromes (ACS). We tested the hypothesis that admission glucose adds relevant prognostic information to the GRACE Score. METHODS: Consecutive patients admitted with ACS had plasma glucose measured at admission and cardiovascular events were defined as death, non-fatal myocardial infarction or non-fatal refractory angina during hospitalization. RESULTS: Among the 148 patients studied, 11.5% developed cardiovascular events. Patients in the forth quartile of admission glucose (> or =175mg/dl) had a greater incidence of events, compared with those in the first 3 quartiles (22% vs. 8.1%; RR=2.7; 95%CI 1.1-6.4; P=0.03). Plasma glucose remained a predictor of events, after adjustment for diabetes (P=0.03). After adjustment for the GRACE Score, glucose in the forth quartile lost its predictive value (P=0.29). Plasma glucose added to GRACE did not improve the C-statistics (0.82; 95%CI 0.75-0.88), as compared with the original Score (0.81; 95%CI 0.74-0.87). Net reclassification improvement by new score was -0.03 (P=0.86), indicating no useful reclassification. CONCLUSION: Despite its association with adverse events, admission plasma glucose does not improve GRACE's accuracy to predict in-hospital events in patients with ACS.
