Comparison of TIMI, Pursuit, Grace Risk Scores in Indians with NSTEMI: A Prospective Cohort Study
Journal Title: Journal of Cardiovascular Medicine and Surgery - Year 2019, Vol 5, Issue 2
Abstract
Background: Patients with non ST elevation myocardial infarction (NSTEMI) are a very heterogenous population, with varying risks of early and longterm adverse events. Early risk stratification at admission seems to be essential for planning therapeutic strategy. There are scores for this. They include the TIMI, PURSUIT and GRACE risk score. In this study we sought to compare these risk scores in a NSTEMI cohort. In the subgroup of patients with syntax score, the TIMI, PURSUIT and Grace risk scores were compared with syntax score in prognosticating patients with NSTEMI. Materials and methods: This is a prospective cohort study conducted in a tertiary care hospital catering to patients from Karnataka, Tamil Nadu and Andhra Pradesh states of India. All patients with NSTEMI admitted to the coronary care unit from 01.08.2011 to 30. 04.2013 were included in the study after informed consent. Patients were followed up for adverse cardiac events including NSTEMI, unstable angina, ST elevation myocardial infarction, congestive cardiac failure, interventions and mortality which included in hospital, 30 day and 1 yr mortality. The followup was done till 31st July 2013. Results: A total of 213 patients with NSTEMI were included in this study. The mean age of the cohort was 61 ± 12 years. 69.4% (148) were males. Univariate predictors of early mortality included low systolic (p – 0.010), low diastolic blood pressures (p – 0.048) and patient with CCS Class IV at admission (p – 0.019). Univariate predictors of longterm (1 year) mortality includes age (p -0.000), low systolic (p – 0.030) and low diastolic (p -0.001) blood pressure, low ejection fraction (p – 0.002), low hemoglobin (p - 0.004), high serum creatinine ( p – 0.009). The GRACE RS was good (AUC – 0.890 CI: 0.77 – 0.99) as compared to TIMI (Fair – AUC – 0.778) and pursuit (good – AUC – 0.865) in predicting In hospital mortality. Long-term mortality prediction was same with all risk scores (AUC – 0.7). Syntax had a better predictability for shorterm and long-term mortality when compared to the other scores. This subgroup is not a random sample and hence may not represent the cohort as a whole. Conclusion: In an Indian cohort of NSTEMI, GRACE risk score was better than TIMI and PURSUIT risk scores in discriminative and predictive accuracy for in hospital and shorterm (30 days) mortality. The three risk scores were similar in predicting long-term mortality. Low hemoglobin and diastolic blood pressure are not part of these scores but were independently associated with long term mortality in our cohort.
Authors and Affiliations
Veenu J
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- DOI 10.21088/jcms.2454.7123.5219.4
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