[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.
Full-text · Article · May 2010 · Arquivos brasileiros de cardiologia
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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).
Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS.
Full-text · Article · Apr 2010 · Clinica chimica acta; international journal of clinical chemistry