Comparative assessment of short-term prognosis in patients with ST-segment elevation acute coronary syndrome without percutaneous coronary intervention based on the GRACE, TIMI, RECORD, PREDICT scales

Abstract

Aim. To conduct a comparative assessment of the short-term prognosis in patients with ST-segment elevation acute coronary syndrome (STE-ACS) without percutaneous coronary intervention (PCI) based on the Global Registry of Acute Cardiac Events (GRACE), Thrombolysis In Myocardial Infarction (TIMI), RECORD, PREdicting risk of Death In Cardiac disease Tool (PREDICT) scales and to ident ify the most significant markers of fatal and non-fatal complications.Material and methods. Eighty-two STE-ACS patients without PCI were examined. Risk assessment was carried out using the GRACE, TIMI, RECORD, and PREDICT scales. Outcomes were assessed 30 days after markers. To assess the predictive value of above scales, sensitivity (Se) and specificity (Sp), as well as relative risk with a 95% confidence interval, were calculated.Results. Comparative analysis of the prognosis of developing fatal complications in STE-ACS patients without PCI revealed the following predictive characteristics of scales: GRAСE — Se=1,000, Sp=0,54, χ2=25,763 (p<0,001); PREDICT — Se=0,281, Sp=0,96, χ2=20,297 (p<0,001); TIMI — Se=0,75, Sp=0,94, χ2=51,985 (p<0,001); RECORD — Se=1,000, Sp=0,48, χ2=21,716 (p<0,001). Regarding the development of non-fatal complications, the following data was obtained: GRACE — Se=0,680, Sp=0,760, χ2=9,970 (p<0,01); PREDICT — Se=0,080, Sp=1,000, χ2=4,167 (р>0,05); TIMI — Se=0,120, Sp=1,000, χ2=8,171 (р<0,05); RECORD — Se=0,680, Sp=0,640, χ2=5,128 (р<0,05). The most significant criteria for developing fatal and non-fatal complications were identified as follows: Killip class II acute heart failure, systolic blood pressure <100 mm Hg, age >65 years, stage ≥II A chronic heart failure, ST elevation ≥1 mm at admission, ejection fraction ≤<40%.Conclusion. A comparative evaluation of the 30-day prognostic significance of short-term scales (GRACE, RECORD, TIMI, PREDICT) in STE-ACS patients without PCI showed an ambiguous prognosis for developing both fatal and non-fatal complications. High sensitivity rates for predicting fatal complications were revealed in the GRACE and RECORD scales (100 and 100%, respectively) relative to the TIMI and PREDICT (75 and 28,1%, respectively), as well as for non-fatal complications in the GRACE and RECORD (68% for both) scales relative to the TIMI and PREDICT (12 and 8%, respectively).

Keywords

• st-segment elevation acute coronary syndrome
• shortterm prognostic scales