Prediction of 30-day outcomes for ST elevation myocardial infarction by TIMI and GRACE scores in a non-percutaneous intervention facility –A preliminary observation
Journal Title: JOURNAL OF MEDICAL COLLEGE CHANDIGARH - Year 2017, Vol 7, Issue 1
Abstract
Introduction: Risk stratification in acute coronary syndrome (ACS) is an important determinant of interventional management strategies and outcomes for patients. Use of scoring systems help in predicting short term adverse outcomes and may be useful in medical centres which do not have coronary intervention facilities to provide decision for early referral to centres having these facilities. The TIMI risk score is based on a simple set of risk factors, clinical, laboratory and electrocardiographic variables while the GRACE score has a more detailed set of parameters. These scores are easy to administer in emergency settings and provide a rapid means of assessment for patient management decisions. Aims of the study: To analyze the risk factors for patients with STEMI and apply TIMI and GRACE risk scores for risk stratification, and clinical outcome of the patients during the first 30 days. Materials and Methods: A cohort of 48 consecutive patients with STEMI managed with non-interventional therapy in the emergency department was prospectively studied. Observation and Results: The mean age in the study population was 55 ± 12 years. It included 35 males (73%, mean age 54 ± 12 years) and 13 females (27%, mean age 63±8 years). 18.8% patients had diabetes mellitus (DM), 37.6% were hypertensive and 54.2% were smokers. 52.1% had family history of DM, hypertension or previous coronary artery disease. Anterior wall myocardial infarction was most common (54%) followed by inferior wall (42%) and left bundle branch block (4%). TIMI risk score was calculated in 40, while GRACE score was calculated in all 48 patients. TIMI score ranged from 1 to 9 with a mean of 4±2. GRACE score ranged from 70 to 204 with a mean of 144±30. The two scores were compared with each other and Spearman's test for correlation showed excellent relationship (r value=0.633) (p-value <0.05). A TIMI score of 6 and GRACE score of 170 gave maximum sensitivity and specificity for predicting outcome. Conclusions: Age of patient correlated well with both scores and outcomes. GRACE risk score (p value=0.003) demonstrated better discrimination than the TIMI risk score (p value=0.057) in predicting death during a 30-day follow up. Thus, accurate risk stratification of patients could be done with the GRACE score (cutoff score of 170), which may help in tailoring therapeutic strategy and deciding in early referral to cardiac centers with facilities for intervention.
Authors and Affiliations
Gargi Das, Monica Gupta, Sarabmeet Singh Lehl, Kamal Singh, Ram Singh
Keywords
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