0277: Risk assessment for the management of STEMI: which score fits best for the Tunisian context?

Abstract

Risk assessment after ACS is essential. Risk scores have been mainly used in Non-STEMI patients; nevertheless, patients with STEMI should also be screened according to their risk. Scores have been validated in European and American populations but have not been tested in African populations. to compare the short term prognosis according to the GRACE and TIMI scores for STEMI GRACE and TIMI scores for STEMI were calculated for patients who were admitted for STEMI between January 2000 and June 2012. All variables included in each score were tested by univariate analysis then included in multivariate model. ROC curve was assessed for each score. 1162 patients were included in our analysis. 132 deaths occurred during the study period. All variables included in both scores were tested by univariate analysis and were significantly correlated to intra-hospital mortality except time delay to reperfusion >4hours (p=0.38). By multivariate analysis, the model provided 88.6% power to predict mortality and explained 35.1% of the outcome. Mean GRACE and TIMI scores were significantly higher in the mortality Group (respectively: 198 vs 149 and 7.46 vs 5.88; p<0.001). ROC curve was then drawn for each score; GRACE score provided a better accuracy in predicting the outcomes (AUC: 0.862, CI 95% [0.788-0.863]) than TIMI score (AUC: 0.715, CI 95% [0.668, 0.762]) In the North African context, GRACE score seems to be more powerful in predicting intra-hospital mortality after STEMI and therefore it should be calculated in every patient.