Accuracy of the TIMI and GRACE scores in predicting coronary disease in patients with non-ST-elevation acute coronary syndrome

Abstract

Introduction: The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease. Methods: We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score. Obstructive CAD was defined as ≥50% stenosis in the left main or ≥70% stenosis in other vessels. Severe CAD was defined as a SYNTAX score >32. The Pearson test was used to assess the correlation between scores. Results: The SYNTAX score was higher in patients at high risk (GRACE score: p32. O teste Pearson foi usado para avaliar a correlação entre os scores. Resultados: O valor do score Syntax foi superior nos doentes de alto risco (escore GRACE: p<0,001 e o score TIMI: p=0,001). Além disso, houve uma correlação significativa positiva entre os scores GRACE e Syntax (r=0,23, p<0,001), assim como entre os scores TIMI e Syntax (r=0,2, p=0,002). Ambos os scores clínicos podem de certo modo prever DC obstrutiva (score GRACE: AUC=0,599 (p=0,015); score TIMI: AUC=0,639 (p=0,001), mas não uma doença grave. Um score GRACE=120 e um score TIMI=2 foram fatores preditores da DC obstrutiva com uma sensibilidade de 57% e de 75,7% respetivamente e uma especificidade de 61,8% e de 47,9%. Conclusão: Os scores GRACE e TIMI estão ligeiramente correlacionados com a extensão da doença coronária avaliada pelo score Syntax. Podem prever uma DC obstrutiva, mas não uma doença grave. Keywords: Acute coronary syndrome, Correlation, Coronary artery disease, Scores, Prognosis, Palavras-chave: Síndrome coronária aguda, Correlação, Doença coronáia, Scores, Prognóstico